PMC9720439_01
Abdominal ultrasonography findings at the first visit. (A) Transverse plane abdominal ultrasonography showing a ureterocele (white arrowhead).. (B) Sagittal plane abdominal ultrasonography showing a dilated right ureter (black arrowhead) behind the bladder.
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Abdominal ultrasonography showed no hydronephrosis but indicated a dilated right lower ureter with a cystic structure in the bladder, suggestive of a ureterocele (Fig. 1A and B).
Voiding cystourethrography findings. (A) The defect (arrow) is observed slightly to the right in the bladder by injecting a contrast medium of 50 mL from a 6-F catheter in the supine position.. (B) Voiding cystourethrography performed in a standing position showed no urethral obstruction (arrowhead) or vesicoureteral reflux; however, the defect (arrow) reappeared and moved to the bladder neck mid-voiding.. (C) The moment the defect (arrow) had prolapsed into the urethra, the contrast medium within the urethra flowed out and the urethra was no longer visible.
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Initially, a defect was observed on the right side of the bladder when a contrast agent was injected through a 6-F catheter (Fig. 2A). VCUG in a standing position revealed no urethral obstruction or vesicoureteral reflux; however, the bladder defect reappeared during the middle stage of voiding (Fig. 2B). Subsequently, the urinary stream was interrupted, and the urethra became invisible when the defect moved to the bladder neck and prolapsed into the urethra (Fig. 2C).
Transvesicoscopy toward the bladder neck (A-E) and postoperative uroflowmetry findings (F) (A) The ureterocele (asterisk) is located in the bladder neck.. (B) The ureterocele (asterisk) was resected using a monopolar hook. A 5-cm-long 8-F catheter is inserted in the right ureter.. (C) The right ureter (white arrow) was dissected using the monopolar hook.. (D) The site of the newly created ureteral orifice and submucosal tunnel using scissor forceps. The white and black arrows indicate the right ureter and left ureteral orifice, respectively. A 5-cm-long 5-F catheter is inserted in the left ureter.. (E) The bladder mucosa was repaired after performing a ureteroneocystostomy. The star indicates the new ureteral orifice.. (F) Postoperative uroflowmetry showing a bell-shaped curve.
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Transvesicoscopic findings showed the ureterocele at the bladder neck, obscuring the internal urethral orifice (Fig. 3A). The ureterocele was resected using a monopolar hook (Fig. 3B), and the right ureter was dissected (Fig. 3C). At the site of the new ureteral orifice (above the left ureteral orifice) (Fig. 3D), a submucosal tunnel was created using scissor forceps, and the right ureter was drawn gently through the tunnel. Subsequently, a ureteroneocystostomy was performed using interrupted 4-0 and 5-0 absorbable sutures, and the bladder mucosa was repaired using 5-0 absorbable sutures (Fig. 3E). A postoperative UFM also showed a bell-shaped curve (maximum flow rate, 37.6 mL/s; average flow rate, 21.6 mL/s; voided volume, 318.5 mL) (Fig. 3F), and bladder ultrasonography after voiding showed no residual urine.