Cecoureterocele: Morphology and Clinical Correlations

Abstract

A unique necropsy specimen of a cecoureterocele, together with the bladder and urethra in a female newborn, was studied to determine the structure of the ureterocele and the accompanying vesicourethral sphincter. The ureterocele within the bladder base and the entire urethra were examined macroscopically and microscopically in serial sections. The ureterocele and its cecal extension were amuscular. The bladder neck, and the involuntary and voluntary sphincters were attenuated or devoid of muscle in the quadrant beneath the ureterocele and its cecal extension. These findings were correlated with the clinical features of 2 living patients with comparable ureteroceles who had urinary incontinence following surgical excision of the ureteroceles.

Surgical treatment for ureterocele with special reference to lower urinary tract reconstruction

“…In addition to diminished muscularity at the bladder neck and proximal urethra, the muscle deficit at the intrinsic sphincter from bilateral coecoureterocele may predispose to urinary incontinence. 11 Developmental abnormality of normal sphincter mechanism at or distal to the bladder neck is postulated to cause urinary incontinence in ureterocele. The hypomuscularity of the trigone, internal sphincter, and proximal urethra that backed the ureterocele should be repaired in bladder level reconstruction.…”

“…We believe that the primary purpose for patients with ureterocele, especially of the ectopic type, is to reconstruct the original pathology of the lower urinary tract that gives rise to reflux, obstruction, and abnormalities of urination 7 . The morphological findings of ectopic ureterocele indicate that musculature at the bladder neck and posterior urethra is normal in anterior, but severely compromised in posterior quadrants 11 . In cases of broad based ureteroceles, weakness of musculature extends cranially in the involved trigone and medially to the contralateral ureterovesical junction.…”

“…Weakness of her sphincter function could be congenital in origin. In addition to diminished muscularity at the bladder neck and proximal urethra, the muscle deficit at the intrinsic sphincter from bilateral coecoureterocele may predispose to urinary incontinence 11 . Developmental abnormality of normal sphincter mechanism at or distal to the bladder neck is postulated to cause urinary incontinence in ureterocele.…”

“…7 The morphological findings of ectopic ureterocele indicate that musculature at the bladder neck and posterior urethra is normal in anterior, but severely compromised in posterior quadrants. 11 In cases of broad based ureteroceles, weakness of musculature extends cranially in the involved trigone and medially to the contralateral ureterovesical junction. A muscle defect may predispose to incontinence and , paradoxically, to outlet obstruction from protrusion of the bladder neck and posterior urethra similar to congenital bladder diverticulum in neonates or infants.…”

Case of Large Cecoureterocele with Contralateral Renal Rupture in Neonate

“…A cecoureterocele is an uncommon type of ureterocele, where the blind pouch of the ureterocele is elongated beyond its orifice by tunneling into submucosa under the bladder trigone and through the urethra [1,2]. This blind pouch of the ureterocele fills during voiding and actually causes bladder outlet obstruction.…”