Ureterocele and Ureteral Duplication in Children

A ureterocele is a problem with a ureter. The ureter is a tube that connects the kidney to the bladder. There is 1 ureter for each kidney. The ureters send urine from the kidneys to the bladder. A ureterocele is when part of a ureter right near the bladder becomes larger and bulges. This happens because the ureter’s opening into the bladder is too small and blocks urine flow. This causes urine to back up in the ureter. The ureter then swells with too much urine.

Children who have a ureterocele may also have ureteral duplication. This means having 2 ureters for each kidney instead of 1 ureter for each kidney. Each ureter drains into the bladder. The ureter with the ureterocele often drains urine from the top half of the kidney. The duplicate ureter may drain the lower half. The ureter with the ureterocele may enter the bladder lower than the duplicate ureter. This may cause urine backflow (reflux) into the higher ureter.

Experts don't know what causes ureterocele and ureteral duplication. But some cases have occurred in siblings. This means a change in a gene may be a cause.

These problems are much more common in girls than in boys. Girls often have a ureterocele in both ureters. In boys often only 1 ureter is affected. They are also more common in whites compared to other races.

These conditions often don't cause symptoms. They are often first identified on a prenatal ultrasound. But in some children, they may lead to urinary tract infections (UTIs) in the first few months of life and repeat infections later. UTIs can cause symptoms.

UTI symptoms in babies can include:

• Fever
• Bad-smelling urine
• Irritability
• Crying
• Fussiness
• Vomiting
• Poor feeding
• Diarrhea

UTI symptoms in children can include:

• Sudden need to pee (urinate)
• Need to pee often
• Loss of control of urine (incontinence)
• Pain while peeing
• Trouble peeing
• Pain above the pubic bone
• Blood in the urine
• Bad-smelling urine
• Nausea and vomiting
• Fever
• Chills
• Pain in the back or side below the ribs
• Tiredness

Some of these symptoms can be caused by other health conditions. Take your child to see their healthcare provider for a diagnosis.

A ureterocele may be first seen on a prenatal ultrasound, while the baby is still in the uterus. In some cases, it may not be found until the child has a UTI. Then your child may have tests, such as:

• Ultrasound of the entire urinary tract.  This imaging test uses sound waves and a computer to create images of blood vessels, tissues, and organs. The test is used to see internal organs as they work, and to look at blood flow through vessels.
• Voiding cystourethrogram.  This is a type of X-ray of the urinary tract. The healthcare provider puts a thin, flexible tube (catheter) in the tube that drains urine from the bladder to the outside of the body (the urethra). The provider fills the bladder with a liquid dye. X-ray images are taken as the bladder fills and empties. The images will show if your child has any reverse flow of urine into the ureters and kidneys.

When a ureterocele and ureteral duplication are diagnosed, your child's healthcare provider will likely order a kidney (renal) scan. This is done to see how well the kidney is working.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is. Your child may be referred to a urologist. This is a healthcare provider who treats the urinary tract and the male genital tract.

First, a UTI will be treated with fluids and antibiotic medicines. The healthcare provider will decide if your child will be treated in a hospital and if they need antibiotics given by IV (intravenous) line. This will be based on your child's age and on how bad the condition is. Children younger than 2 months old and those who seem sicker will almost always be treated in the hospital with IV antibiotics. In other cases, antibiotics may be given by mouth. In some cases, you may be able to get IV antibiotics at home. Once the UTI is gone, the ureterocele will be treated.                                    

Treatment of the ureterocele often depends on how much the ureter is blocked. It also depends on how well the affected kidney is draining. A small ureterocele may not need treatment if the kidney is working well enough.

But, in most cases, a child may need surgery. If the area of the ureter has a lot of urine buildup, it may need to be drained with surgery. Larger ureteroceles that cause a lot of urine backflow (reflux) into the kidney may need to be removed or fixed with surgery. In some children, the kidney of the affected side may be damaged. The surgeon may need to remove part of that kidney.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

If not treated, a ureterocele may cause recurrent UTIs and kidney damage.

Call the healthcare provider if your child has:

• Symptoms that don’t get better or that get worse
• New symptoms

• A ureterocele is a problem with a ureter. There is 1 ureter for each kidney that sends urine from the kidneys to the bladder. A ureterocele is when part of a ureter right near the bladder becomes larger and bulges.
• Children who have this may also have ureteral duplication. This means having 2 ureters for each kidney instead of 1 ureter for each kidney.
• These problems are much more common in girls than in boys.
• These conditions often don't cause symptoms. But in some children, they may lead to repeat urinary tract infections (UTIs). Symptoms of a UTI can include fever, need to urinate often, pain, and crying.
• A small ureterocele may not need treatment if the kidney is working well enough. In other cases, a child may need surgery.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.