Congenital ureteric diverticula in children and adults: classification, radiological and clinical features

Sarajlić, M; Durst-Zivković, B; Svoren, E; Vitković, M; Batinić, Danica; I, Bradić; Vucković, I

doi:10.1259/0007-1285-62-738-551

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…[1][2][3] In the reported cases, the ureteral diverticulum was totally resected with or without end-to-end anastomosis of the ureter. [1][2][3][4] In the present case, ureteral stenting was helpful in designing the surgery, a partial excision of the diverticulum, without damaging the ureter. In addition, our experience shows the difficulty in diagnosing a ureteral stone in the diverticulum.…”

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A case of calculus in the true ureteral diverticulum

Mori

Yamada

Homma³

2011

Int J of Urology

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A 65-year-old woman was referred to our hospital due to repeated asymptomatic gross hematuria over a few months. Physical examination and blood tests were both unremarkable. An abdominal computed tomography (CT) scan showed left hydroureteronephrosis and a ureteral stone, 15 mm in diameter, in the left lower ureter (Fig. 1a, yellow arrow). The thickened ureteral wall and some fluid space around the stone were also detected (Fig. 1a, red arrow). Before her scheduled admittance for further examinations, acute septic pyelonephritis by Klebsiella pneumoniae developed , which necessitated placement of a ureteral stent. Upon insertion of a guidewire in the ureter, purulent urine passed from the left ureteral orifice. The ureter was dilated and tortuous, but had no obvious stricture. The stone was detected in a pouch of the ureter, located approximately 6 cm above the vesicoureteral junction. Unlike ureterocele, a diverticulum itself might not cause hydroureteronephrosis, but the stone inside it could compress the ureter. A silicone type double J ureteral stent was placed in the ureter to resolve the pyelonephritis. A postoperative excretory urogram showed subsidence of the left hydroureteronephrosis and revealed calculus in the ureteral diverticulum (Fig. 1b).Two months later, the patient was admitted again for diverticulectomy and ureterolithotomy. The ureter was approached by the left Gibson incision. After dividing extensive periureteral fibrosis, a sharp incision was made longitudinally on the ureteral diverticulum, away from the ureter, and the calculus was extracted with forceps (Fig. 1c). The stone was composed of 85% calcium oxalate and 15% uric acid (Fig. 1d). The composition was the same for the internal core and the outer layer. The diverticulum was partially excised and sutured with the stent placed in the ureter. Histopathological examination of resected diverticulum showed all layers, including the muscularis layer of the ureter, indicating a true congenital diverticulum (Fig. 1e). The stent was removed 7 weeks postoperatively. The patient was free of symptoms and hydroureteronephrosis after 9 months of clinical follow up.Ureteral diverticula are categorized into (i) true congenital diverticula, involving all layers of the ureter and (ii) acquired pseudodiverticula, formed by protrusion of the mucous membrane. 1 There are only three reports on calculus in a true ureteral diverticulum, and our report is the second case in Japan. 1-3 In the reported cases, the ureteral diverticulum was totally resected with or without end-to-end anastomosis of the ureter. 1-4 In the present case, ureteral stenting was helpful in designing the surgery, a partial excision of the diverticulum, without damaging the ureter. In addition, our experience shows the difficulty in diagnosing a ureteral stone in the diverticulum. Fluid space around the stone on CT scan is suggestive of a stone in the diverticulum, which should be confirmed by retrograde pyelonephrography. Without recognizing the diverticulum, the diverticular orifice m...

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confidence: 64%

“…There are only three reports on calculus in a true ureteral diverticulum, and our report is the second case in Japan 1–3 . In the reported cases, the ureteral diverticulum was totally resected with or without end‐to‐end anastomosis of the ureter 1–4 …”

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A case of calculus in the true ureteral diverticulum

Mori

Yamada

Homma³

2011

Int J of Urology

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“…Women are more likely than men to develop ureteral diverticula. UD are usually left-sided and asymptomatic but may present with pyuria or recurrent UTIs [ 7 ]. UD is principally diagnosed via excretory urography.…”

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confidence: 99%