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CASE REPORT H. NORMAN NOE* From the Department of Urology, University of Tennessee Center fc,r the Health Sciences, Memphis, Tennessee

ABSTRACT

Single orthotopic ureteroceles are uncommon in childhood. A recent case of such a ureterocele causing obstructive symptomatology is presented. A similar case has not been specifically reported previously. V. T., a 4-year-old black was seen in 1974 at another institution with obstructive symptomatology and enuresis. Diagnosis was meatal stenosis and a meatotomy was done in the office. The child did well until 1977 when he was first

copy confirmed the diagnosis of a single orthotopic ureterocele. The child underwent excision of the ureterocele and reimplantation of the ureter. Postoperatively, the symptoms disappeared and the followup IVP and voiding cystourethrogram are normal. DISCUSSION

Cystic dilatation of the terminal ureter is congenital and believed to be the result of the persistence of the Chwalla membrane. Ureteroceles are either single and orthotopic or ectopic with the single form being seldom seen in children. These ureteroceles rarely cause bladder outlet obstruction and usually are associated with urinary tract infectimL The ectopic ureterocele has been described and documented and is now well accepted, H It is almost always associated with ureteral duplication and the cases of prolapse previously described primarily in female children have all been associated with this condition. No x-ray studies were obtained at the initial office visit in 1974, when the child underwent meatotomy. It is interesting to note the complete cessation of symptoms with removal of the obstructive meatal stenosis and their subsequent reappearance with obstruction the ureterocele. Also, it is interesting to speculate what interval x-rays might have shown. Assuming that ureteroceles are congenital in nature, the most likely explanation for the delay in the onset of symptoms would be a gradual enlargement and elongation of the ureterocele during the interval. Extensive evaluation and studies usually can be avoided in most cases of meatal stenosis. 7 However, the reappearance of symptoms orginally attributed to obstruction meatal stenosis after mi:,m;oi;,orr,y would certainly serve as an indication for a complete evaluation as in this case. REFERENCES

L Williams, D. I. and Woodard, J. R: Problems in the management of ectopic ureteroceles. J. UroL, 92: 635, 1964. of 94 instances in 80 infants 2. Campbeli, M.: Ureterocele: a and children. Surg., Gynec. & 93: 705, 195L

referred to us with recurrence of hesitancy, accidents and enuresis. and urine Physical examination revealed a normal caliber meatus and no other abnormalities. An excretory urog:ram (IVP) revealed left lower ureterectasis. A voiding cystourethrogram showed a cystic and smooth wall filling defect in the bladder that was noted at the time of fluoroscopy to prolapse into the posterior urethra during voiding (see figure). Cystos-

3. Gross, R. E. and Clatworthy, H. W., Jr.: Ureterocele in infancy

and childhood. Pediatrics, 5: 68, 1950. R. S., Kelalis, P. P., Burke, E. C. and Stickler, G. B.: Simple and ectopic ureterocele in infancy and childhood. Surg., Gynec. & Obst., 134: 611, 1972. 5. Stephens, F. D.: Intramural ureter and ureterocele, Postgrad. Med. J., 40: 179, 1964. 6. Thompson, G. J. and Kelalis, P. P.: Ureterocele: clinical appraisal of 176 cases. J. Urol., 91: 488, 1964. 7. Noe, H. N. and Dale, G. A.: Evaluation of children with meatal stenosis. J. Urol., 114: 455, 1975. 4, Malek,

Accepted for publication November 4, 1977.

* Requests for reprints: Department of Urology, University of Tennessee Center for the Health Sciences, 800 Madison, P.O. Box 63635, Memphis, Tennessee 38163. 367

Prolapsing single orthotopic ureterocele in a boy: case report.

1,iVilkins BOY: CASE REPORT H. NORMAN NOE* From the Department of Urology, University of Tennessee Center fc,r the Health Sciences, Memphis, Tenness...
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