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?
Endoscopic incision
Nephrectomy with paial ureterectomy
STING operation
Lich-Gregoir technique
- 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)
Kidney and ureter