Ureteroceles in Children, with Emphasis on the Frequency of Ectopic Ureteroceles

The most common type of ureterocele in infants and children is an intravesical and intraurethral protrusion of a dilated ureter which passes submucosally in the vesical wall before ending ectopically in the urethra. Termed an ectopic ureterocele, it differs significantly in pathologic anatomy from the better known simple ureterocele. The latter characteristically occurs in the adult and consists of an intravesical cystic expansion of a ureter immediately proximal to its opening in the urinary bladder. In general, ectopic ureteroceles are much larger than simple ureteroceles, have a different location within the bladder, cause more severe symptoms, and have a less favorable prognosis. Since most of them produce a recognizable pattern on excretory urography, it is important that both the radiologist and the urologist be familiar with their pathologic anatomy. To Ericsson (1954) belongs the credit for first drawing attention to the pathologic anatomy and frequency of ectopic ureteroceles (1), although he was able to list 19 previously reported cases. His study is evidently not widely known in the United States, notwithstanding its incorporation in a monograph published in this country in 1957 (3). The purposes of the present preliminary report are to describe the pathologic anatomy of simple and ectopic ureteroceles and to record their relative frequency in the case material of the Cincinnati Children's Hospital from Jan. 1, 1950 to Oct. 1, 1959. Radiographic, cystoscopic, and surgical findings, symptomatology, and therapy will be considered in the final report. The pathologic anatomy of a simple ureterocele is shown diagrammatically in Figure 1. Although the involved ureter may not terminate in the usual location on the trigone, it always opens in the urinary bladder and therefore is not considered to be ectopic. The ureterocele is contained completely in the bladder, except in those rare instances when it prolapses into the urethra (4). Occurring with equal frequency in the two sexes, such ureteroceles comprise only about one-fourth of the ureteroceles which are discovered in pediatric patients. Simple ureteroceles are usually small and do not occupy any great part of the bladder. Their radiographic appearance has been likened to a “cobra head” or “spring onion.” The characteristic feature of an ectopic ureterocele (Fig. 2) is the submucosal passage of the distal portion of the involved ureter for a variable distance within the vesical wall before terminating in the urethra. Ectopic ureters which end elsewhere than in the urethra never possess a sufficiently intimate relationship with the vesical mucosa to form ureteroceles (3). Almost always the involved ureter is supernumerary and drains the upper pole of the kidney via either a small pelvis or, less commonly, a point in the renal parenchyma without any identifiable pelvis (1). In either case, there is function of the involved portion of the kidney and the ectopic ureter contains urine.