The ureter is a tube that carries urine from the kidneys to the bladder, and if it does not develop properly at the end, it can bulge and form a small pouch that blocks the flow of urine. This bulge or pouch is called a ureteral cyst. Ureteral cysts are a congenital defect disease with an incidence of about 1 in 2000. Ureteral cysts are more common in girls, 10 times more often than in boys, because the disease of the double collecting system (one kidney with two ureters) is more common in women. Ureteral cysts are most often diagnosed by ultrasound or voiding cystourethrography (VCUG) within two years of age. In many cases, the ureter or its effects can be visualized by ultrasound before birth. Some children with ureteral cysts may have some damage to the kidneys if they develop vesicoureteral reflux (having a reverse flow of urine into the kidney). Small ureteral cysts may not require any treatment at all. If the blockage is not severe, your child’s doctor may choose to just watch her for a while to make sure the condition is not getting worse, but sometimes surgery is needed to repair your child’s ureteral cysts. No! The same disease can cause multiple pathophysiological changes, and ureteral cysts can vary greatly in terms of severity and location. Some ureteral cysts are almost nonexistent, while others can occupy the entire bladder. The severity of a ureteral cyst depends on its size and the degree to which it subsequently causes obstruction. Mild: A small ureter (the most common type) will only slightly interfere with the flow of urine between your child’s kidneys and bladder. Her doctor may choose to just continue to monitor her to make sure the condition is not getting worse. Severe: Larger ureteral cysts can lead to more severe blockage of the urine flow. This can cause problems such as urinary tract infections, vesicoureteral reflux, and even kidney damage. So, what clinical symptoms can ureteral cysts produce to get our early attention? Mild Small ureteral cysts only slightly obstruct the flow of urine, so most children with ureteral cysts will not have any symptoms. Severe Larger ureteral cysts can cause a variety of symptoms; by far the most common is urinary tract infection (UTI). Common symptoms in children with UTI include: Fever? Painful or burning sensation during urination? Strong or foul-smelling urine? Sudden episodes of frequent urination Loss of urine (wet pants during the day and night) A large ureteral cyst may also cause one or more of the following symptoms in your child: abdominal bulging (if the ureteral cyst prevents urine from leaving the bladder)? Urinary incontinence? Blood in the urine Growth retardation? abdominal pain? Pain in the lower abdomen? Difficulty urinating? Recurrent urinary tract infections Are there any other complications associated with ureteral cysts? Ureteral cysts can put your child at risk for the following complications: Vesicoureteral reflux (VUR) – a condition in which urine can flow upward from the bladder back into the kidneys, leaving your child vulnerable to kidney infections and kidney damage. Hydronephrosis – a condition in which urine builds up and causes the kidneys to swell. Less commonly, ureteral cysts may promote the formation of kidney stones. If left untreated or misdiagnosed, large ureteral cysts can damage your child’s kidneys and urinary system. Chronic urinary reflux into the kidney, infection and obstruction can cause irreversible kidney function damage and may even require surgery to remove the affected kidney. This is why it is crucial to see a urologist for an accurate and timely diagnosis. So, what are the long-term effects of a ureteral cyst? If your child has a large ureteral cyst that puts her kidneys at risk, surgery may be needed to avoid permanent kidney damage. However, even the most severe ureteral cysts can still be treated effectively if they are caught early. With an accurate diagnosis, appropriate treatment and careful management, your child should be able to achieve normal urinary function. Treatment of ureteral cysts Can ureteral cysts be prevented? No. Ureteral cysts are congenital disorders. However, urinary tract infections associated with ureteric cysts can usually be prevented with antibiotics. Treatment of ureteral cysts depends on when they get diagnosed and how severe your child’s symptoms are. If a routine prenatal ultrasound has revealed the presence of a ureteral cyst, your child’s doctor will recommend a series of imaging tests after her birth to understand her urinary tract anatomy as well as her kidney function. Based on how large the ureteral cyst is and how much it is affecting the kidneys, your doctor will either continue to monitor her condition or begin treatment: the most common outcome is continued observation. You’ll want to schedule a follow-up appointment for another set of imaging tests in a few months. Daily prophylactic antibiotics (to fight urinary tract infections) approach – in this case, your child will also have to come back in a few months for another set of imaging tests. Surgical removal of ureteral cysts – In rare and serious cases, your child’s doctor may recommend surgery early in infancy to drain the ureter and remove the large ureteral cyst that is putting your child at risk for significant kidney damage. If your child’s kidneys are already damaged, the surgeon may also remove the part of the organ that has lost its function in a procedure called a nephrectomy. In other cases, a ureteral cyst may be removed and the ureter reconnected to the bladder, allowing urine to flow normally and preventing reflux.