Fetal and neonatal ureterocele
A ureterocele is a balloon-like malformation of the area where a ureter, the
tube from the kidney, enters the bladder. This balloon-like structure causes
problems by blocking the normal flow of urine from the kidney causing it to
accumulate in the ureter and in the kidney. This blockage, if not corrected, can
cause the kidney to lose its ability to purify blood and produce urine, and it
can also give rise to dangerous infections after birth. For these reasons this
is an important medical problem even though the baby may appear to be normal at
birth.
Diagnosis of a ureterocele
Ureteroceles are diagnosed prenatally (before birth) using ultrasound (also
known as a ‘sonogram'). Sometimes magnetic resonance imaging (MRI) is useful to
confirm the diagnosis. Most often the sonogram is repeated after birth to
confirm the diagnosis. Other imaging techniques such as IVP (intravenous
pyelogram) or retrograde cystogram are sometimes employed after birth.
The symptoms
There are no symptoms of ureterocele in the baby before
birth, and at the time of birth the newborn examination may be completely
normal. In the newborn period, swelling may be noted and urinary infection may
develop. One problem with this abnormality is that symptoms may not be present
until after damage to the kidney has occurred.
Treatment of ureterocele
The condition usually requires a simple operation shortly
after birth to cut the balloon-like structure so that urine may freely drain
into the bladder. This procedure is called a cystoscopy and is performed under
general anesthesia without making an
external incision (cut in the
skin). When the problem can be
corrected with cystoscopy, it is usually done as an outpatient procedure, and
the baby can go home later that day without significant pain. Sometimes more
extensive surgery is necessary. It is important to correct the urine blockage,
if possible, before damage to the kidney has occurred.
The long-term outlook
Once normal urine flow is established, children are
watched carefully for infection, but the outlook for normal urinary function is
very good.