Roberto Villagómez-Camargo1, Marco Chopin-Gazga1, Jonathan Saucedo-Bravo1, Eugenio García-Cano2, Álvaro Montiel-Jarquín3. 1. Servicio de Urología, Hospital General Regional No. 36, Instituto Mexicano del Seguro Social. Puebla, México. 2. Jefatura de División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia Instituto Mexicano del Seguro Social. Puebla, México. 3. Jefatura de División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia Instituto Mexicano del Seguro Social. Puebla, México; Academia Nacional de Educación Médica de México, México. Electronic address: dralmoja@hotmail.com.
Abstract
BACKGROUND: Ureterocele is a cystic dilation of the distal ureteral segment. The incidence in women ranges from 1/5,000 to 1/12,000. In adults, they are poorly diagnosed and are asymptomatic. Prolapse through the urethra is uncommon, and involves acute urine retention and a reducible vulvar tumour. CLINICAL CASE: Woman of 24 years old, two previous caesarean and two abortions. She had incomplete bladder emptying, intermittent voiding, bladder straining and tenesmus, three months before admission. After the voiding effort she presented with acute urine retention with sudden onset of tumour in the vulva. The tumour was manually reduced under regional anaesthesia. A cystoscopy was performed, finding an ischaemic de-roofing of the anterior wall of the ureterocele, causing vesicoureteral reflux grade IV. Surgical correction was performed with Cohen re-implantation and insertion of a double-J catheter. The catheter was removed 30 days later, with a successful post-operative course. DISCUSSION: Its aetiology is unclear, and most are diagnosed by ultrasound in the prenatal period. The clinical presentation is variable, from urinary tract infection to prolapse. Despite its size, it may cause complications such as ischaemic de-roofing, which if diagnosed soon may be resolved successfully, as with this patient. CONCLUSION: The results and treatment may be favourable when no renal impact or concomitant anatomical changes are present, as is the case of this patient.
BACKGROUND: Ureterocele is a cystic dilation of the distal ureteral segment. The incidence in women ranges from 1/5,000 to 1/12,000. In adults, they are poorly diagnosed and are asymptomatic. Prolapse through the urethra is uncommon, and involves acute urine retention and a reducible vulvar tumour. CLINICAL CASE: Woman of 24 years old, two previous caesarean and two abortions. She had incomplete bladder emptying, intermittent voiding, bladder straining and tenesmus, three months before admission. After the voiding effort she presented with acute urine retention with sudden onset of tumour in the vulva. The tumour was manually reduced under regional anaesthesia. A cystoscopy was performed, finding an ischaemic de-roofing of the anterior wall of the ureterocele, causing vesicoureteral reflux grade IV. Surgical correction was performed with Cohen re-implantation and insertion of a double-J catheter. The catheter was removed 30 days later, with a successful post-operative course. DISCUSSION: Its aetiology is unclear, and most are diagnosed by ultrasound in the prenatal period. The clinical presentation is variable, from urinary tract infection to prolapse. Despite its size, it may cause complications such as ischaemic de-roofing, which if diagnosed soon may be resolved successfully, as with this patient. CONCLUSION: The results and treatment may be favourable when no renal impact or concomitant anatomical changes are present, as is the case of this patient.