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CASE REPORT: URETREOCELE IN ADULT FEMALE

Introduction
A ureterocele is a sacculation of the terminal portion of the ureter. It may be
either intravesical (orthopic) or ectopic; in the latter case, some portion is
located at the bladder neck or in the urethra. 1 Although the reported incidence of
ureteroceles varies between 1/5000 and 1/12 000, it is higher in autopsy series
and tends to increase due to the widespread use of prenatal ultrasounds. 2 In
adults, ureteroceles usually remain asymptomatic and/or unrecognized. The
prolapse of a ureterocele through the urethra, causing a vulval mass, is a wellknown but rare event in girls.3 The prolapse of a simple, single-system
ureterocele causing a vulval mass in an adult patient is thus a very rare event
and, to our knowledge, only six cases have been reported until 2006. 4
Transurethral incision (TUI) is a good management option for orthotopic
ureterocele. But most of the literature has shown its efficacy only in children. 5 We
reported an adult female patient with single system ureterocele present with
vulval mass.
Case Reports
A 48-year-old woman came to our clinic with lump at the vulva. There was no
hematuria and no dysuria. Physical examination found a non tender right vulval
mass, 3 cm in diameter and vaginal septal. Abdominal ultrasonography showed
small and contracted right kidney. Thus, follow by IVP that showed non visualized
right kidney. Laboratory of renal function test was normal. Endoscopic studies
demonstrated a slight mucosal bulging on right of the trigone. Transurethral
incision (TUI) was performed. The next day open excision was performed due to
persisten mass. Long term follow up did not reveal any simptom.
Discussion
Knowledge of the etiology, evaluation and treatment of cystic lesions of the
vagina is essential as these lesions are often encountered in urological and
gynecological practices. A vaginal cyst may be an embryological derivative,
ectopic tissue or urological abnormality. Awareness of the various diagnoses of
benign cystic lesions of the vagina and associated abnormalities will aid in
evaluation and treatment. Ureteroceles are commonly associated with the upper
pole of a duplicated collecting system, and if present with an ectopic ureter, may
present as a cystic vaginal mass. Although diagnosis is usually made at an early
age, an ectopic ureterocele may present as incontinence in an older girl or young
woman.6
The goals of the endoscopic technique are to decompress the obstructive
uropathy while minimizing the operative morbidity. Unroofing, puncture, laser
incision, and Collins knife incision are methods used to decompress the
ureterocele.5 Endoscopic incision as for TUI is an initial procedure for
management. Even though it is the simplest and least invasive form of treatment
particularly for single system ureteroceles, some urologists prefer ureterocele

excision and ureteral reimplantation because of the risk of inducing reflux. 7


Ectopic ureteroceles, duplex systems and reflux are associated with increased
reoperation rates after TUI.8
References
1. Kogan BA. Disorders of the Ureter and Ureteropelvic Junction. In: Tanagho
EA, McAninch JW (eds). Smiths General Urology, 17th edn. The McGraw
Hill Company, New York, 2008; 559-73.
2. Cooper CS, Snyder HM III. Ureteral anomalies: the ureter. In: Gillenwater JY,
Grayhack JT, Howards SS, Mitchell ME (eds). Adult and Pediatric Urology.
Lippincott Williams & Wilkins, Philadelphia, 2002; 216276.
3. Mandell J, Colodny A, Lebowitz RL, Bauer SB, Retik AB. Ureteroceles in
infants and children. J. Urol. 1980; 123: 921.
4. Sen I, Onaran M, Tokgoz H, et al. Prolapse of a simple ureterocele
presenting as a vulval mass in a woman. International Journal of Urology.
2006; 13: 447448.
5. Vijay MK, Vijay P, Dutta A, et al. The Safety and Efficacy of Endoscopic
Incision of Orthotopic Ureterocele in Adult. Saudi J Kidney Dis Transpl.
2011; 22(6):1169-1174.
6. Eilber KS, Raz S. Benign Cystic Lesions Of The Vagina: A Literature Review.
J. Urol. 2003; 170: 717-722.
7. Gunar C, Mir E, encan A, et al. Pediatric Ureteroceles: Diagnosis,
Management and Treatment Options. Iran J Pediatr. 2010; 20 (4): 413-419.
8. Byun E, Merguerian PA. A Meta-Analysis of Surgical Practice Patterns in the
Endoscopic Management of Ureteroceles. J. Urol. 2006; 176: 1871-1877.
9. Peters CA, Schlussel RN, Mendelsohn C. Ectopic ureter, ureterocele, and
other anomalies of the ureter. In: Kavoussi LR, Wein AJ, et al (eds).
Campbells Urology, 10th ed. W.B. Saunders, Philadelphia, 2012; 200752.

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