Ureteroceles present a diagnostic and treatment challenge in adults (11. Derisavifard S, Motamedinia P, Okeke Z, Smith A. Diagnosis and Management of a Prolapsing Intravesical Ureterocele in a Man. J Endourol Case Rep. 2015; 1:9-10.). With an estimated prevalence of 1/500 to 1/4000, it is not uncommon for any urologist to encounter ureteroceles in clinical practice (22. Rompré-Brodeur A, Andonian S. Adult Bilateral Ureteroceles Presenting with Lower Urinary Tract Symptoms and Acute Urinary Retention. Case Rep Urol. 2018; 2018:3186060.). The incidence of prolapsed ureteroceles in adults is unknown (33. Abraham N, Goldman HB. Transurethral excision of prolapsed ureterocele. Int Urogynecol J. 2014; 25:1435-6.).
Materials and Methods:
We present an interesting case of a 53-year-old male with a 20-year history of obstructive voiding symptoms who presented with urinary retention with a Foley catheter in place. Pre-operative evaluation included a transrectal ultrasound of the prostate which revealing prostate volume of 20cc. Urodynamics revealed a high-pressure, low flow voiding pattern with a functional detrusor muscle. Cystourethroscopy was performed revealing an orthotopic ureterocele on the left side that was prolapsed into the prostatic urethra, and the bladder neck was elevated. The patient then underwent holmium laser ureterocele excision with transurethral incision of the prostate (TUIP). Using MOSES technology and laser settings of 30Hz and 1.5J, the ureterocele was completely excised and a TUIP was performed.
The patient was discharged home on the day of surgery with a Foley catheter in place. On post-operative day 1 he passed a voiding trial with a post-void residual volume of 25cc. Renal ultrasonography was performed 3 months postoperatively revealing no hydronephrosis. His postoperative International Prostate Symptom Score of 2 was improved compared to his preoperative score of 34.
Holmium laser ureterocele excision with a TUIP is an effective treatment modality in the management of a prolapsed orthotopic ureterocele causing bladder outlet obstruction in a male patient.
- TUIP Transurethral Incision of the Prostate
1Derisavifard S, Motamedinia P, Okeke Z, Smith A. Diagnosis and Management of a Prolapsing Intravesical Ureterocele in a Man. J Endourol Case Rep. 2015; 1:9-10.
2Rompré-Brodeur A, Andonian S. Adult Bilateral Ureteroceles Presenting with Lower Urinary Tract Symptoms and Acute Urinary Retention. Case Rep Urol. 2018; 2018:3186060.
3Abraham N, Goldman HB. Transurethral excision of prolapsed ureterocele. Int Urogynecol J. 2014; 25:1435-6.
Publication in this collection
30 July 2021
Date of issue
26 May 2020
13 July 2020
10 Mar 2021