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Case profile: Pseudoureterocele following ESWL
CASE PROFILE : PSEUDOURETEROCELE FOLLOWING ESWL PROFILE A sixty-two-year-old Hispanic woman had a several-month history of right flank pain and microhematuria . An intravenous pyelogram disclosed a radiopaque calculus 2 .5 cm in diameter in the right renal pelvis . Because of the microhematuria she underwent a cystoscopy that showed a normal bladder. She was hospital-
alerted to the possibility of rehospitalization for possible ureteral meatotomy, ureteroscopy, and manipulation of stone fragments, with or without a percutaneous nephrostomy. Since the patient was symptom-free, conservative management was recommended . Within the following three weeks, all the stone fragments were passed spontaneously, painlessly, and without requiring any intervention . A repeat cystoscopy once again showed a normal bladder. The weight of the fragmented stone mass was probably responsible for the radiologic im-
Intravenous pyelogram (KUB) showing large calculus in right renal pelvis (A) ; fifteen-minute FIGURE 1 . film showing moderate hydronephrosis without evidence of ureterocele (B) ; after ESWL, with column of ureteral calculi fragments (Steinstrasse) with saccular formation at level of ureteral orifice, suggestive of ureterocele (cobra head) (C); and one month after ESWL showing absence of calculi after conservative treatment and spontaneous passage of all fragments . (D) .
ized, and extracorporeal shock-wave lithotripsy (ESWL) was performed for the right renal calculus . Satisfactory fragmentation was obtained, and the patient was discharged on the first day after treatment . On follow-up as an outpatient, x-ray films (KUB) disclosed a large column of stone in the lower third of the ureter with a saccular formation at the level of the ureteral orifice resembling the cobra head seen in ureteroceles (Fig . 1A, B) . The patient was
UROLOGY
i
age compatible with a ureterocele without anatomic defect (Fig . 1C, D) . The development of this pseudoureterocele should be first managed conservatively,
SEPTEMBER 1987 / VOLUME XXX, NUMBER 3
Louis R. Cos, M .D. Department of Urology, Box 656 University of Rochester Medical Center 601 Elmwood Avenue Rochester, New York 14642
287
alerted to the possibility of rehospitalization for possible ureteral meatotomy, ureteroscopy, and manipulation of stone fragments, with or without a percutaneous nephrostomy. Since the patient was symptom-free, conservative management was recommended . Within the following three weeks, all the stone fragments were passed spontaneously, painlessly, and without requiring any intervention . A repeat cystoscopy once again showed a normal bladder. The weight of the fragmented stone mass was probably responsible for the radiologic im-
Intravenous pyelogram (KUB) showing large calculus in right renal pelvis (A) ; fifteen-minute FIGURE 1 . film showing moderate hydronephrosis without evidence of ureterocele (B) ; after ESWL, with column of ureteral calculi fragments (Steinstrasse) with saccular formation at level of ureteral orifice, suggestive of ureterocele (cobra head) (C); and one month after ESWL showing absence of calculi after conservative treatment and spontaneous passage of all fragments . (D) .
ized, and extracorporeal shock-wave lithotripsy (ESWL) was performed for the right renal calculus . Satisfactory fragmentation was obtained, and the patient was discharged on the first day after treatment . On follow-up as an outpatient, x-ray films (KUB) disclosed a large column of stone in the lower third of the ureter with a saccular formation at the level of the ureteral orifice resembling the cobra head seen in ureteroceles (Fig . 1A, B) . The patient was
UROLOGY
i
age compatible with a ureterocele without anatomic defect (Fig . 1C, D) . The development of this pseudoureterocele should be first managed conservatively,
SEPTEMBER 1987 / VOLUME XXX, NUMBER 3
Louis R. Cos, M .D. Department of Urology, Box 656 University of Rochester Medical Center 601 Elmwood Avenue Rochester, New York 14642
287