Nitya Abraham1, Howard B Goldman. 1. Female Pelvic Medicine and Reconstructive Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10-1, Cleveland, OH, 44195, USA, nitya.abraham@gmail.com.
Abstract
INTRODUCTION: A ureterocele is a cystic dilation of the terminal ureter. The incidence ranges from 1/500 to 1/1,200. Ureteroceles are more commonly diagnosed in women; 10% are bilateral, and 80% are associated with the upper pole of a duplicated system. A prolapsed ureterocele is one that extends to or beyond the urethral meatus, and the incidence is unknown. Managing prolapsed ureterocele in adult women is not well described in the literature. METHODS: The aim of this video is to demonstrate the technique of transurethral excision of a prolapsed ureterocele associated with a normal kidney in an adult woman, which eliminates the ureterocele while avoiding the morbidity of open surgical excision. RESULTS: The patient initially underwent transurethral incision of the ureterocele, after which her obstructive symptoms improved. However, she still complained of a mass protruding from her urethra. The patient subsequently underwent transurethral excision of the ureterocele. On the 18-month follow-up, she was voiding without difficulty and had no residual urethral mass. She is being followed clinically, and upper urinary tract imaging will be performed to rule out hydronephrosis or vesicoureteral reflux, as indicated. Pathology revealed urothelial mucosa. CONCLUSION: Transurethral incision of a prolapsed ureterocele can be attempted as first-line treatment due to the low morbidity of the procedure. If the patient still has lower urinary tract symptoms, transurethral excision can successfully treat a large prolapsed ureterocele.
INTRODUCTION: A ureterocele is a cystic dilation of the terminal ureter. The incidence ranges from 1/500 to 1/1,200. Ureteroceles are more commonly diagnosed in women; 10% are bilateral, and 80% are associated with the upper pole of a duplicated system. A prolapsed ureterocele is one that extends to or beyond the urethral meatus, and the incidence is unknown. Managing prolapsed ureterocele in adult women is not well described in the literature. METHODS: The aim of this video is to demonstrate the technique of transurethral excision of a prolapsed ureterocele associated with a normal kidney in an adult woman, which eliminates the ureterocele while avoiding the morbidity of open surgical excision. RESULTS: The patient initially underwent transurethral incision of the ureterocele, after which her obstructive symptoms improved. However, she still complained of a mass protruding from her urethra. The patient subsequently underwent transurethral excision of the ureterocele. On the 18-month follow-up, she was voiding without difficulty and had no residual urethral mass. She is being followed clinically, and upper urinary tract imaging will be performed to rule out hydronephrosis or vesicoureteral reflux, as indicated. Pathology revealed urothelial mucosa. CONCLUSION: Transurethral incision of a prolapsed ureterocele can be attempted as first-line treatment due to the low morbidity of the procedure. If the patient still has lower urinary tract symptoms, transurethral excision can successfully treat a large prolapsed ureterocele.