A 10 years old girl was evaluated for recurrent UTI and dysuria. IVP finding is given below. What is the preferred treatment option for this case?
- In IVP, bilateral terminal poion of ureters is dilated (Ureterocele)-Adder head /Cobra head appearance. - Ureterocele causes outflow obstruction which causes backflow pressure changes-Hydroureteronepehrosis- So, diagnosis - Bilateral Ureterocele with bilateral hydroureteronephrosis. Ureterocele- Cystic dilatation of terminal ureter- MC in Females- Types* Intra- Vesical (20%)* Ectopic (80%) - A/W duplication of ureter- In Intravesical ureterocele - Terminal pa of ureter is cystic & dilated and is inside the bladder- In ectopic ureterocele - Duplication of ureter and the upper pole of ureter is having ectopic ureteric orifice Clinical presentation- Recurrent attacks of UTI/ Urosepsis- Unilateral Hydro-uretero nephrosis- Palpable mass Investigations- On USG - Hydroureteronephrosis with cyst in the bladder- On IVP - Adder Head/ Cobra- head appearance- IOC for diagnosis - IVP- On MCU - Filling defect in bladder- On Cystoscopy - Enlarging and collapsing cyst in the bladder Treatment- Depends on type of ureterocele* In intravesical ureterocele - Incision over the cyst wall (Free flow of urine intobladder)* In ectopic ureterocele - Excision and reimplantation into bladder ? MC Congenital abnormality of upper urinary tract - Duplication of ureter (AD)? MC Congenital abnormality of urogenital tract - VUR (AD)
Endoscopic incision
Nephrectomy with paial ureterectomy
STING operation
Lich-Gregoir technique
Kidney and ureter