American Journal of Roentgenology, Vol 165, 409-413, Copyright © 1995 by American Roentgen Ray Society
Ureterocele eversion with vesicoureteral reflux in duplex kidneys: findings at voiding cystourethrography
RD Bellah, FR Long and DA Canning
Department of Radiology, Children's Hospital of Philadelphia, PA 19104, USA.
OBJECTIVE. Ureterocele eversion refers to the sudden appearance of a
bladder diverticulum at the site of ureterocele compression during voiding
cystourethrography (VCUG). The radiologic appearance closely resembles a
congenital bladder (paraureteral) diverticulum. Distinguishing ureterocele
eversion with vesicoureteral reflux in duplex kidneys from congenital
bladder diverticula with reflux is important for preoperative planning.
This study describes the findings of ureterocele eversion and lower pole
vesicoureteral reflux in duplex kidneys on VCUG and demonstrates how its
appearance can be misleading. MATERIALS AND METHODS. Medical records,
sonograms, and cystograms were reviewed retrospectively for 12 children who
had VCUGs demonstrating bladder diverticula with vesicoureteral reflux and
who, at surgery, had ureteroceles associated with duplex systems. Each case
was assessed as to whether the finding of a diverticulum with reflux on
VCUG had been correctly interpreted as ureterocele eversion with lower pole
vesicoureteral reflux. RESULTS. Diagnosis of ureterocele eversion with
lower pole reflux was uncertain or misinterpreted as congenital bladder
diverticula with reflux in five patients in whom ureteroceles were not
identifiable or in whom reflux occurred into what resembled single systems
rather than lower poles of duplex systems. In two patients in whom
ureteroceles were not initially identified, fluoroscopy recognized
ureterocele eversion with lower pole reflux. Sonography confirmed
ureterocele in one of these patients, and cystoscopy in the other.
CONCLUSION. Ureterocele eversion with lower pole vesicoureteral reflux is
readily diagnosed by VCUG when a ureterocele is initially identified or if
the fluoroscopic appearance is typical. Ureterocele eversion with lower
pole reflux can be mistaken for a congenital paraureteral diverticulum with
reflux into a single collecting system if the ureterocele is small or not
initially detected or if the refluxed system is not recognized as a lower
pole moiety.
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