Ureterocele

 Masculino 04 años edad con trastornos urinarios desde su nacimiento.Ha presentado infecciones urinarias intermitentes. El examen sonografico abdominal muestra riñon derecho con multiples imagenes anecogenas,quisticas , de diferentes tamaños y formas que ocupan practicamente todo el parenquima renal. En polo superior destaca imagen anecogena con abundantes grumos finos en su interior compatible con proceso infeccioso (pionefrosis). El riñon luce marcadamente aumentado de tamaño,mide aprox 17,8 X 9,3 X 8,52 cm. El riñon izquierdo muestra dilatacion significativa de la pelvis renal y multiples imagenes anecogenas,quisticas, diseminadas por el parenquima renal. El riñon mide aprox 9,86 X 3,64 X 5,43 cm.El examen sonografico de la vejiga muestra paredes engrosadas,regulares. En su interior no se visualizan polipos o calculos.En lado derecho se visualiza imagen anecogena,quistica del ureter distal derecho, de gran tamaño,se corresponde con ureterocele grado III. Esta anomalia es congenita y suele ser de cuatro a seis veces mas frecuente en niñas ( lo contrario a este caso ),suele asociarse ( 80 %) a doble sistema excretor ureteral ( no en este caso).Se aprecian ambos jets ureterales presentes aunque con flujo disminuido. Se mide la orina residual siendo esta menor al 10 %.Se concluye con los diagnosticos de : 

1.-Poliquistosis renal bilateral

2.-Pionefrosis renal derecha

3.-Ureterocele Grado III ureter derecho

En lo personal me llama la Atencion dos cosas:

1.-La rareza, para mi, de casos similares en este pais, ya que estaba acostumbrado a ver casos durante mis trabajos en España, donde ver ureteroceles era bastante frecuente, sobre todo en mujeres de edad avanzada, supongo que su frecuencia alli estaba relacionada con una cuestion racial; hay que pensar que su incidencia es menor aqui debido a la gran mezcla racial que tenemos,

2.- Casi todos los casos que diagnostique en España era grado I o II, no recuerdo haber detectado un grado III alli.

URETEROCELE

Male 04 years of age with urinary disorders since birth, has had intermittent urinary infections. The abdominal sonographic examination shows the right kidney with multiple anechoic and cystic images of different sizes and shapes that occupy practically the entire renal parenchyma. In the upper pole, an anechoic image stands out with abundant fine lumps in its interior compatible with an infectious process (pyonephrosis). The kidney is markedly enlarged, measuring approx 17.8 X 9.3 X 8.52 cm. The left kidney shows significant dilatation of the renal pelvis and multiple anechoic, cystic images disseminated through the renal parenchyma. The kidney measures approximately 9.86 x 3.64 x 5.43 cm, sonographic examination of the bladder shows thickened regular walls. Inside, no polyps or calculi are seen. On the right side, a large anechoic, cystic image of the right distal ureter is seen, corresponding to grade III ureterocele. This anomaly is congenital and is usually four to six times more frequent in girls (the opposite to this case), it is usually associated (80%) with a double ureteral excretory system (not in this case). Both ureteral jets are present although with a decreased flow. Residual urine is measured, being less than 10%, and it is concluded with the diagnoses of:

1.-Bilateral polycystic kidney disease

2.-Right renal pyonephrosis

3.-Ureterocele grade III right ureter

Personally, two things call my attention:

1.-The rarity, for me, of similar cases in this country, since I was used to seeing cases during my work in Spain, where seeing ureteroceles was quite frequent, especially in elderly women, I suppose that its frequency was there related to a racial issue; You have to think that its incidence is lower here due to the great racial mix we have,

2.- Almost all the cases that I diagnosed in Spain were grade I or II, I don't remember having detected a grade III there.