What is a ureterocele? Could your child have this condition?

Does your little one get frequent urinary tract infections (UTIs)? Or did your doctor mention something like a small swelling in your baby's kidneys during a scan during your pregnancy? One possible cause of these things is a condition called Ureterocele. You may not have heard of this name before. But don't worry. This is something new for many parents. Let's talk about it simply and clearly today.

Simply put, what is Ureterocele?

Okay, let's first understand how the urinary system in our body works very simply. We have two kidneys in our body. These are the ones that filter our blood and remove unnecessary things as urine, or urine . The urine that is made in this way is collected in the bladder along two tubes. Those two tubes are called ureters . When the bladder is full, we feel the need to urinate .

Now, in a condition called ureterocele, the end of the ureter, which carries urine from the kidney to the bladder, swells up like a balloon. Imagine that the end of a water pipe is slightly swollen. It's something like that. Due to this swelling, urine cannot flow properly into the bladder. Then, the urine is pushed back up, that is, towards the kidney. In medicine, we call this (Vesicoureteral Reflux) . Having urine go back into the kidney like this is not good for the health of the kidneys at all.

Are there main types of ureterocele?

Yes, doctors divide this condition into several types. You don't have to have a lot of knowledge about these, but it's good to have a general understanding.

• Depending on the side affected: Sometimes this can occur in just one kidney (unilateral). That is the most common type. Very rarely, this condition can occur in both kidneys (bilateral).
• By location:
• Extravesical Ureterocele: This is the most common type in infants and young children. Here, the balloon-like bulge can extend all the way down to the bladder, including the bladder neck and urethra.
• Intravesical Ureterocele: In this type, the bulge is entirely inside the bladder. It does not extend outside the bladder.

These classifications are very important for the doctor to determine treatment methods.

How common is this condition? Who is most likely to get it?

This is not a very common condition. It affects about one in 5,000 children. It is also more common in girls than boys.

What are the symptoms of a ureterocele?

In most cases, a small ureterocele may not cause any symptoms. However, the problem starts when the urine can't flow properly, leading to a urinary tract infection (UTI) . When a child develops a UTI, they may show these symptoms:

If your child has any of these symptoms, it is very important to see a doctor immediately .

Why is this happening? What is the reason for this?

As we mentioned earlier, this is because the end of the ureter doesn't develop properly while the baby is developing in the womb. Sometimes symptoms can also appear in adulthood, but the cause is the same.

Is this serious? What complications can occur?

Ureterocele is a treatable condition, but it should be taken seriously. If left untreated, it can lead to serious complications.

Because, when urine does not flow properly and fills up in the kidneys (urinary retention), urinary tract infections (UTIs) develop. When these infections continue to develop, they begin to damage the kidneys .

Other risks are:

• Kidney stones
• Bladder damage
• Recurrent urinary tract infections (UTIs)

How do doctors find this?

Fortunately, most Ureteroceles are diagnosed during prenatal ultrasound scans.It can be identified by the scan itself. Usually, during the anomaly scan, which is done around 20 weeks, the doctor will suspect that one of the baby's kidneys or ureters is swollen. This can then be confirmed through tests after the baby is born.

Sometimes it is diagnosed after the baby is born. It is usually discovered during tests done when symptoms appear before the age of 2. It can also be discovered incidentally during tests done in adults for kidney stones or urinary tract infections.

Your doctor may recommend one or more of these tests:

How is a ureterocele treated?

The treatment method is determined by several factors.

• When is the disease diagnosed? (During pregnancy or in childhood?)
• Have the kidneys been affected?
• Do you have vesicoureteral reflux?

If this is detected during a scan during pregnancy, antibiotics can be given to reduce the risk of infection until the baby is born. After the baby is born, the best treatment will be determined based on the baby's condition.

The main treatment method is surgery.

Surgical treatments

The main goal of the surgery is to remove the balloon-like swelling and relieve the blockage in the urinary tract . There are several methods for this.

1. Transurethral Puncture: This is like pricking a balloon with a needle. The surgeon inserts a thin instrument (cystoscope) with a camera along the urethra, goes into the bladder, and makes a small hole in the swollen ureterocele. This allows the blocked urine to flow freely. This is usually not a major surgery, and you can go home the same day without staying in the hospital (outpatient procedure). However, this is done under general anesthesia for children.

2. Ureteral Reimplantation: This is a slightly more complicated surgery. Here, the surgeon makes a small incision in the lower abdomen and enters the bladder. Then, the part of the ureter with the ureterocele is cut out and removed, and the tube is reattached to the bladder. The flap valve that prevents urine from flowing backward is also repositioned. This surgery is very successful in 90% - 95% of cases.

3. Upper Pole Nephrectomy: This surgery is done in very special cases. Some children may have a duplex kidney. This means that one kidney on one side is divided into two parts. If the upper pole of this kidney is severely damaged by the ureterocele and it is not working at all, the non-working part is surgically removed.

Watchful waiting

This is usually done in adults. If the ureterocele is very small, there are no symptoms, and there is no damage to the kidneys, the doctor may decide to observe the condition without surgery.

Can this condition be completely cured?

Yes, absolutely. Ureterocele can be completely cured with surgery. Once the blockage in the flow of urine is removed, the problem is solved. But as we said earlier, if there is already damage to the kidneys, that damage cannot be repaired. The best thing to do is to stop further damage. That is why early diagnosis and treatment are so important.