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Ultrasonography
On antenatal sonograms, the typical presentation is that of an enlarged hydronephrotic fetal kidney. Renal
duplication and/or ureteral duplication may be seen. Intravesical cystic dilation or septa within the bladder (which
represent ureterocele walls) suggest that the etiology of the hydronephrosis may be a ureterocele. Such antenatal
ultrasonographic findings warrant comprehensive postnatal evaluation and confirmation of the diagnosis.
[5]
Renal/bladder ultrasonography
The initial study performed for the evaluation of a neonate with fetal hydronephrosis with or without a suspected
ureterocele should be renal and/or bladder ultrasonography.
[7]
During every postnatal ultrasonographic evaluation of
antenatal hydronephrosis, examining the bladder is imperative to avoid missing associated ureteroceles. The
sonographic finding of a well-defined cystic intravesical mass within the posterior bladder wall is suggestive of a
ureterocele.
The classic description is that of a cyst within a cyst, as in the first 2 images below. Occasionally, the dilated
intramucosal section of the ureter may be visualized as it inserts into the bladder and terminates in the
ureterocele, as seen in the last 3 images below. Ultrasonography also defines the degree of hydronephrosis, and it
possibly depicts renal dysplasia as cortical thinning. With their distinct echogenic renal pelves, duplex renal
systems may also be identified on the initial ultrasonographic examination. This finding should exclude any solid
periureteric orifice mass in the bladder, such as a pseudoureterocele.
Transverse sonogram of the pelvis depicts the bladder with a ureterocele. The cyst within a cyst is a pathognomonic radiologic sign of
ureterocele.
Transverse sonogram of the pelvis depicts the bladder with ureterocele. The cyst within a cyst is a pathognomonic radiologic sign of a
ureterocele.
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Dr. S Alfiana

Ureterocele Imaging
Author: Ganesh Raj, MD, PhD; Chief Editor: Eugene C Lin, MD more...

Updated: Sep 12, 2013
Longitudinal sonogram of the pelvis depicts the submucosal course of the dilated ureter within the bladder.
Longitudinal sonogram of the pelvis depicts the submucosal course of the dilated ureter within the bladder.
Longitudinal sonogram of the pelvis depicts the submucosal course of the dilated ureter within the bladder. The dilated ureter ends in the
ureterocele.
Degree of confidence
Antenatal ultrasonography is increasingly becoming the modality for diagnosing prenatal ureteroceles. Findings of
a cyst within the bladder and hydronephrosis are virtually diagnostic of a ureterocele. However, any finding on
antenatal sonography must be confirmed with comprehensive postnatal ultrasonographic evaluation.
Hydronephrosis may be associated with ureteroceles, but it is not pathognomonic.
Renal and/or bladder ultrasonography is highly sensitive for the detection of ureteroceles and widely used. Similar
to all other imaging modalities, smaller ureteroceles may be compressed and thus missed on sonograms.
[8]
False positives/negatives
With antenatal ultrasonography, prolapsed ureters, bladder diverticula, and mesonephric duct cysts may resemble
the ureterocele on prenatal images, and they may contribute to false-positive findings; however, the finding of a
cyst within a cyst should be diagnostic.
The habitus of the mother, orientation of the fetus, filling status of the fetal bladder, motion artifacts, presence of
comorbid conditions in the fetus or mother, and skill of the sonographer may significantly affect the quality of
prenatal sonograms. The fetal bladder must be visualized to make the diagnosis. Often, the fetal bladder may not
be imaged adequately, or the ureteroceles may be compressed, leading to false-negative findings. In such cases,
associated hydronephrosis is often detected.
With renal and/or bladder ultrasonography, prolapsed ureters, bladder diverticula, and mesonephric duct cysts all
may resemble ureteroceles on postnatal sonograms, and they may contribute to false-positive findings. The
detection of ureteroceles is compromised in patients with unobstructed or minimally obstructed systems because
of the small size of the ureteroceles and the lack of associated ureteral or pelvic dilation.
Furthermore, because ureteroceles are compressible, they may be missed when the bladder is full. If the bladder
is empty, sonography may not discriminate between ureterocele and bladder walls. For optimal visualization of the
ureterocele, sonography must be performed with the patient's bladder distended and empty.

Contributor Information and Disclosures
Author
Ganesh Raj, MD, PhD Associate Professor, Department of Urology, University of Texas Southwestern
Medical Center
Ganesh Raj, MD, PhD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.
Coauthor(s)
John S Wiener, MD, FACS, FAAP Associate Professor of Surgery and Associate Residency Program
Director, Division of Urologic Surgery, Associate Professor of Pediatrics, Duke University School of Medicine
John S Wiener, MD, FACS, FAAP is a member of the following medical societies: Alpha Omega Alpha,
American Academy of Pediatrics, American College of Surgeons, American Medical Association, American
Urological Association, Society for Fetal Urology, Society for Pediatric Urology, and Society of University
Urologists
Disclosure: Glaxo Smith Kline Consulting fee Consulting
Richard A Leder, MD Department of Radiology, Associate Clinical Professor, Division of Abdominal Imaging,
Duke University School of Medicine
Richard A Leder, MD is a member of the following medical societies: American Roentgen Ray Society,
American Urological Association, Radiological Society of North America, and Society of Uroradiology
Disclosure: Nothing to disclose.
Specialty Editor Board
Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt
Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.
Joshua A Becker, MD Professor, Department of Radiology, New York University School of Medicine
Joshua A Becker, MD is a member of the following medical societies: Society of Uroradiology
Disclosure: Nothing to disclose.
Robert M Krasny, MD Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and
Radiological Society of North America
Disclosure: Nothing to disclose.
Chief Editor
Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency
Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington
School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine,
American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

Medscape Reference © 2011 WebMD, LLC
References
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3. do Nascimento H, Hachul M, Macedo A Jr. Magnetic resonance in diagnosis of ureterocele. Int Braz J
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4. Payabvash S, Kajbafzadeh AM, Saeedi P, Sadeghi Z, Elmi A, Mehdizadeh M. Application of magnetic
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5. Kajbafzadeh AM, Payabvash S, Sadeghi Z, Elmi A, Jamal A, Hantoshzadeh Z, et al. Comparison of
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Pediatr Urol. Feb 2008;4(1):32-9. [Medline].
6. Cerwinka WH, Grattan-Smith JD, Scherz HC, et al. Appearance of Deflux implants with magnetic
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7. Becker AM. Postnatal evaluation of infants with an abnormal antenatal renal sonogram. Curr Opin Pediatr.
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8. Zougkas K, Kalafatis P, Ioannidis S, Katsikas V, Radopoulos D. Assessment of obstruction in adult
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