Presentation
Mass protruding from the vagina. Irregular periods.
Patient Data
The palpable abnormality corresponds with a cystic structure anterior to the vagina and inferior to the symphysis pubis. A shadowing echogenic focus is present along its posterior aspect. There is an apparent left ureteric jet identified within this abnormality noted. Definite direct communication between the abnormality and the bladder was not demonstrated.
MRI confirms a left-sided ureterocoele which descends through the urethra down into the vaginal introitus where it is manifest as a thin-walled blind ending cystic structure. This cystic structure contains a 7 mm calculus.
Urethral catheter with balloon within the bladder and vaginal catheter with balloon within the upper vagina.
Cystic structure with 7 mm calculus along its posterior aspect, is noted to the left of the bladder catheter balloon, consistent with known left ureterocele.
Following urethral instillation of contrast into bladder lumen, the ureterocele appears as a filling defect outlined by contrast on all sides except its most posterior aspect, confirming its location within bladder. It is attached posteriorly to bladder wall very close to the bladder neck, suggesting ectopic inferomedial insertion of the left ureter. The ureter is difficult to identify given the distortion of anatomy from the vaginal cathether balloon.
This study confirms the intravesical location of ectopic left ureterocele that had prolapsed through the bladder neck and urethra on the previous studies, and has now been reposed within the bladder lumen by the bladder catheter.
Case Discussion
A cecoureterocele is a very rare subtype of ectopic ureterocele where the orifice of the affected ureter is within the bladder, but the cavity of the ureterocele extends beyond the bladder neck into the urethra.
Ectopic ureteroceles are more common in girls than boys. They predispose to vesicoureteric refluex and recurrent infections. Calculi may develop in ureteroceles due to urinary stasis.
The overwhelming majority of ureteroceles are associated with a duplex collecting system. A duplex system was not definitively identified in this case but remains suspected given the dilatation of the left upper pole calyces on MRI.
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