Today’s term “ureteral cyst” is equivalent to the English term “Ureterocele”, but such a Chinese translation deprives it of the “-cele” suffix However, such a Chinese translation has lost the meaning of “prolapse” expressed by the “-cele” suffix. Perhaps the state expressed by “cyst” is more intuitive, but “prolapse” would be a more graphic representation of its occurrence.
Above: Ureteral cyst
Above: Ureteral cyst in a different perspective
As you can see from the two pictures above, the lesion is indeed a bulging sac, but it does not appear anywhere else in the ureter, but probably at the end of the ureter and prolapses into the bladder. So although we call it a “ureteral cyst”, we also have to understand that it means “ureteral prolapse”.
The outside of the cyst is covered with the mucosa of the bladder and the inside continues with the mucosa of the ureter, with a thin layer of smooth muscle between the two layers, and under cystoscopy, the cyst can often be seen to be rhythmically contracting and diastolic.
The ureteral opening is somewhere on the cyst, the opening is often narrow and sometimes limited by the angle of the cystoscope, making it difficult to find, but it must be on top of the cyst. The ureter above this side also tends to be dilated due to the narrow opening and poor urination.
Above: Ureteral cyst visible on cystoscopy
What are the dangers of ureteral cysts?
Think upward: Because of the narrow opening of the ureter above the cyst and poor urinary drainage above it, the ureter becomes dilated and the kidney becomes fluid-filled.
Think downward: If the cyst is in the bladder, if it is too large it may block to the outlet of the bladder and even be washed into the urethra by the urine, and the performance is all difficult to urinate.
Thinking to the opposite side: If the bladder has difficulty emptying, lower abdominal pain, urinary retention, or even dilated fluid accumulation in the opposite kidney and ureter can be caused.
Think in situ: Any poor urination, resulting in prolonged retention of urine, can be an important factor in urinary tract infections.
Some fetal hydronephrosis or duplicated kidneys may be found in fetal life accompanied by ureteral cysts, and others are found during postnatal ultrasound follow-up. In some cases, ureteral cysts are found during ultrasound examinations for urinary tract infections. Others are found during ultrasound examinations for urinary difficulties, urinary retention, or hematuria. In some girls, a red mass may even be seen in the urethra, blocking urination.
Above: Bladder and ureteral cysts seen on ultrasound
Routine urinalysis and ultrasound are essential basic tests for children with any urinary problems!
Above: Ureteral cyst (black bulbous shadow in the bladder) seen on an intravenous pyelogram angiogram (IVP) film
Above: Another IVP showing a ureteral cyst that looks like a cobra head (cobra head sign cobra head sign)
Above: Ureteral cyst seen on magnetic resonance (MR) 3D imaging
Above: Ureteral cyst seen on CT
So many of the above tests can show ureteral cysts, so diagnosis is often not a problem, the problem is to think about getting some imaging done when there is a urinary problem. But just being satisfied with the diagnosis of a ureteral cyst is not enough.
Above: Classification of ureteral cysts
Above: Give a picture to see how it would be different. When you see a ureteral cyst, you have to consider its location, the position of the ureteral opening and the presence of a duplicated collecting system.
Above: Ureteral cysts originate from a single collecting system
Above: Ureteral cysts arise from a duplicated collecting system (i.e., duplicated nephron ureteral malformation), and ureteral cysts almost invariably arise from the upper kidney of a duplicated kidney (see: duplicated kidney, not simply multiple kidneys
). Ureteral cysts are more commonly seen in girls, since ureteral malformations of the duplicated kidney are more commonly seen in girls.
The choice of treatment measures depends on the symptoms, the size and specific classification of the cyst, and the function of the corresponding kidney.
If the cyst is small, without clinical symptoms and without urinary tract obstruction, it can be followed up and observed. Long-term prophylactic antibiotics may be applied in the presence of urinary tract infection.
More aggressive treatment is preferred to endoscopic electrodesiccation. It relieves the obstruction of the upper urinary tract and prevents the continued dilatation of the ureter and the aggravation of hydronephrosis, and also prevents the cyst from further enlarging and blocking the bladder outlet.
Above: Endoscopic ureteral cyst opening
Endoscopic electrodesis is likely to be complicated by reflux of the vesicoureter and eventually still requires ureteral reimplantation.
For combined ureteral cysts of the duplicated collecting system, the surgical plan should be made in the context of the function of the upper and lower parts of the duplicated renal ureter. Excision of the upper kidney and its ureter and cyst, or incision of the cyst, will be done on a case-by-case basis. If the two ureters co-sheath into the bladder, it will be much more difficult to handle, and reimplantation of the duplicated ureter may be necessary.
For the diagnosis and treatment of pediatric urologic malformations, it is important to have a global view. Ureteral cysts are not just about cysts.