If your child has been diagnosed with a ureteral cyst, you and your family will be stressed, which we understand, so we will proceed with your child’s treatment in a sensitive and supportive manner for your child and your entire family.
Here are some basics about ureteral cysts.
If the end of your child’s ureter (which is the tube that carries urine from the kidneys to the bladder) is not developing properly, 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 that occurs in about 1 in 2,000 people, most often in Caucasians.
Ureteral cysts are more common in girls, 10 times more often than in boys, because the double collecting system (one kidney with two ureters) is more common in girls.
In some children with ureteral cysts, there may also be a backflow of urine into the kidney, which can damage the kidney (a problem called vesicoureteral reflux).
Large ureteral cysts can also extend into the urethra and block the flow of urine out of the bladder.
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.
Sometimes surgery is needed to repair your child’s ureteral cyst, but if the blockage is not severe, your child’s doctor may choose to just observe her for a while to make sure the condition is not getting worse.
Small ureteral cysts may not require any treatment at all.
Symptoms and causes of ureteral cysts.
What is a ureteral cyst?
A ureteral cyst is a small pouch or bulge at the end of your child’s ureter. Normally, urine flows freely from the kidneys to the bladder, but a ureteral cyst can block some or all of the urine flow, sometimes even causing it to back up into your child’s kidneys. How much the urine flow is affected and whether the kidneys are at risk of being damaged will indicate how serious your child’s condition is.
Are all ureteral cysts the same?
No. Ureteral cysts can vary greatly in terms of severity and location. Some ureteral cysts are almost nonexistent, while others can take up 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 a urinary tract infection, vesicoureteral reflux, or even kidney damage.
Causes: What causes ureteral cysts?
The exact cause of ureteral cysts in children is not known. Such congenital (present at birth; not acquired) problems are often detected by routine prenatal ultrasound, which would suggest that they come from problems with your child’s urinary tract development and how the ureter enters the bladder.
The condition can develop familially, so researchers speculate that there is a genetic component, but no specific gene has been isolated.
Signs and symptoms: What are the symptoms of ureteral cysts?
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 a 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.
Urine loss (wet pants during the day and night).
A large ureteral cyst can also cause one or more of the following symptoms in your child.
A bulging abdomen (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 in urination.
Recurrent urinary tract infections.
Are there any other complications associated with ureteral cysts?
Ureteral cysts can put your child at risk for complications such as
Vesicoureteral reflux (VUR) – , a condition in which urine can flow upward from the bladder back into the kidneys. VUR can make 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 renal impairment and may require surgery to remove a kidney (called a nephrectomy).
This is why it is crucial to see a urologist for an accurate and timely diagnosis.
What will my child’s long-term outcome be?
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.
Examination and diagnosis of ureteral cysts.
The first step in the treatment of your child’s ureteral cyst is to arrive at an accurate and complete diagnosis.
How is a ureteral cyst diagnosed?
Ultrasound: Because ureteral cyst is a congenital (present at birth) condition, it is often detected by prenatal ultrasound before birth as hydronephrosis (enlargement). In some cases, hydronephrosis is detected prenatally, but the ureteral cyst is not discovered until after a more thorough examination is completed after the baby is born.
If it is not detected then, it may not be discovered until your child has recurrent urinary tract infections.
If we notice a ureteral cyst (or hydronephrosis) on prenatal ultrasound, your doctor will usually perform the following tests a few weeks after your baby is born to diagnose the condition and evaluate your child’s urinary tract function.
Renal ultrasound (RUS): This ultrasound focuses specifically on the kidneys and bladder and gives the doctor a general idea of the severity of the hydronephrosis. Ureteral cysts, if present, can also be identified by this image.
Voiding cystourethrography (VCUG): This special type of x-ray is used to understand the anatomy of your child’s bladder and to check for reflux. Using a small tube called a catheter, the doctor injects a fluid containing iodine into your child’s bladder. As the bladder fills up and your child urinates, the flow of fluid will be shown on the X-ray video image.
Kidney scan (DMSA or MAG 3): This is a nuclear scan that helps measure the functional differences between the two kidneys and estimate the degree of urinary blockage. After a tiny amount of radioactive material (radioisotope) is injected into your child’s bloodstream, a special camera called a gamma camera is used to take pictures of the kidneys as the radioactive material passes through the kidneys, showing how well they filter and drain.
Blood tests: These allow the doctor to see how well your child’s kidneys are working.
Urinalysis and urine culture: These are laboratory tests that are done on the urine. These tests can show microscopic blood cells or urine protein, other chemicals, or evidence of a urinary tract infection.
The older children who come to us with some or all of these symptoms of ureteral cysts are diagnosed in the same way.
When we have completed all the necessary tests, our specialists will meet to review and discuss what they have learned about your child’s condition. We will then meet with you and your family and discuss the results and paint a general picture of the best treatment plan for your child.
Treatment of ureteral cysts.
If your child has been diagnosed with a ureteral cyst, your doctor and care team understand that you may be concerned.
How are ureteral cysts treated?
Treatment for ureteral cysts depends on when they get diagnosed and how severe your child’s symptoms are.
If a ureteral cyst has been diagnosed prenatally.
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 affects 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.
Routine prophylactic antibiotic (to fight urinary tract infections) approach — In this case, your child will also have to return 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 properly and preventing reflux.
How often does my baby need to see the doctor?
Babies can be seen every 3-4 months. A series of imaging tests will give us a feel for the size and severity of the ureteral cyst. If we confirm that it is not causing any damage to your child’s kidneys, we will follow up every 6-12 months depending on his age.
Older children with undiagnosed ureteral cysts prenatally may not know about it until your child has recurrent urinary tract infections or becomes ill from a urinary obstruction.
Your doctor may have prescribed antibiotics for your child if in a certain situation. If they don’t start working quickly, we may admit your child to the hospital for more antibiotics and intravenous fluids. In severe cases, we will drain the ureter to stabilize your child and then perform those imaging tests mentioned above to evaluate her condition and decide how to proceed with observation or treatment.
Is it safe to take antibiotics for a long time?
Yes. Giving once-daily, low-dose, preventive antibiotics has helped thousands of children over the years with few serious side effects. There are some risks associated with any medication, but we believe that for children with more severe ureteral cysts, the benefits of preventing urinary tract infections (and kidney scarring) outweigh that small risk associated with prolonged antibiotics.
Children don’t become “immune” to antibiotics, do they?
Children do not become immune to antibiotics. Their immune systems remain fully functional and are not altered by these drugs. However, with prolonged exposure to certain antibiotics, bacteria that live on and inside the body can become resistant to these antibiotics. Since most urinary tract infections are caused by germs that live on our bodies, this can be a problem.
My child needs surgical treatment. What do we do next?
You will meet with your child’s doctor and together you will design a treatment plan that is appropriate for your child’s condition.
What do we need to do to prepare for surgery?
Your child’s doctor will give you a lot of information about what to do and what not to do in the days leading up to your child’s surgery. These instructions include how long before surgery your child should restrict his or her diet, what time you should arrive at the office before surgery, and how long you should be expected to stay in the hospital.
What are the different surgical options?
Open surgery.
If your child’s doctor decides that your child should have traditional open surgery, the incision is a little larger and your child will stay in the hospital a little longer, but the results are very similar.
Endoscopic surgery.
In some cases, the procedure can be performed by inserting a lens into your child’s urethra and also does not require an incision. As you might expect, recovery from this procedure is quick, but not all children are helped by endoscopic techniques.
Which method is better?
The choice of surgical approach is highly individualized and very dependent on the details of your child’s condition. Traditional open surgery is a time-tested method that can correct ureteral cysts with very few complications. Laparoscopic surgery reduces the size of the incision and can be less painful, reducing the amount of time your child needs to stay in the hospital. Your doctor will discuss with you which option is better for your child.
How can a ureteral cyst affect my child’s long-term health?
If your child has a large ureteral cyst that could damage her kidneys, surgery may be necessary. However, even large ureteral cysts can often be treated effectively — your child will achieve normal urinary function.
What makes your approach unique?
Ureteral cysts are a pediatric condition, so it is important that your child should see a specialized pediatric surgeon. These specialists have years of experience dealing with what can sometimes be a delicate and rare condition.
Can ureteral cysts be prevented?
No. Ureteral cysts are a congenital condition. However, urinary tract infections associated with ureteric cysts can usually be prevented with antibiotics.