Bilateral Single System Orthotopic Ureterocele with Bilateral Multiple Calculi Presented with Retention of Urine - an Urological Emergency

Abstract

The ureterocele is an uncommon congenital anomaly of the lower ureter. Ureterocele with a single pelvicalyceal system, bilateral, and orthotopic variety is less common. Calculi within bilateral ureterocele are a rare occurrence. To the best of our knowledge, only a few similar cases have been reported in the literature. Among the all reported presentations of this type of ureterocele, presentation with Acute Urinary Retention (AUR) has not been described in the literature. We present a case of nine-year-old child having bilateral, single system orthotopic ureterocele with calculi in bilateral ureterocele and presented with AUR due to obstructive bulbar urethral calculus. The bilateral endoscopic incision was given and all four calculi were removed endoscopically through percutaneous route. Voiding cystourethrography after two years follow-up was non-refluxing. The purpose of reporting this case is the rarity of the disease and to emphasize that delay in diagnosis and treatment of these cases may lead to complications such as recurrent urinary tract infection and renal failure.

Bilateral Open Ureteroceles with Concomitant Bladder Calculi in an Adult Male

“…One approach commonly cited in the literature involved a low transverse incision using a Collin's knife in a ''smiling'' manner aimed at opening the ureterocele and leaving behind a decompressed ureterocele flap valve serving as an antireflux mechanism. 3 Holmium and potassium titanyl phosphate lasers have also been described in the literature to perform a similar endoscopic incision with similarly low rates of vesicoureteral reflux. 4 Another management option commonly employed is more applicable to severely prolapsed ectopic ureteroceles is endoscopic unroofing.…”