Evanescent ureterocele refers to a transient or intermittently visible ureterocele, which may collapse or disappear spontaneously- either on its own or during voiding. It can be missed if not imaged at the right time or under dynamic conditions. It appears as a transient filling in the bladder during ureteral jet activity.
A ureterocele is a cystic dilation of the distal ureter as it enters the bladder, typically due to a congenital defect in the chwalla membrane at the ureteral orifice.
A 31 year old male came with complaints of lower abdominal pain with voiding difficulty. History of recurrent urinary tract infection present. No other comorbidities.
Ureteroceles are relatively common pathology, with an incidence of 1/500 to 1/4000, with 80% of sufferers being female. They are generally located at the segment of the distal ureter and are often concomitant with a renal duplication. The diagnosis of ureteroceles is important as they may be linked to obstruction, urinary tract infection and hydronephrosis. It is important to treat the ureterocele as the complications they cause may eventually lead to renal failure.
The clear depiction of the inflating and deflating ureterocele was found only due to it being revealed by a ureteric jet. Before the ureteric jet, the appearance was very non-specific, easily being mistaken for a small irregularity in the bladder wall.
The therapy is generally surgical by way of endoscopy, though in some cases the ureterocele requires no treatment. In cases of renal duplication, surgery to remove the problematic kidney segment alongside its ureter.
Occult ureteroceles may be difficult to detect if they only become visible once inflated by ureteric jets. If a slight irregularity in the bladder is observed, it may be worth waiting to see if a ureteric jet reveals an occult ureterocele.
[1] Xie D, Klopukh B, Nehrenz GM, Gheiler E (2017) Review of Presentations, Types and Coexisting Diseases. International Archives of Urology and Complications Ureterocele.
[2] Özdemir Şimşek Ö, Tiryaki S, Erfidan G, et al (2022) Evaluation of Pediatric Patients with a Diagnosis of Ureterocele.
[3] Caione P, Nappo SG, Collura G, et al (2019) Minimally Invasive Laser Treatment of Ureterocele.
Dr. K. Akila Consultant Anaesthesiologist, Kauvery Hospital, Trichy
Dr. VIJAY THIRAVIYAM Consultant Radiologist, Kauvery Hospital, Chennai
Dr. Deepan Post Graduate Resident – Radiology, Kauvery Hospital
