PICTORIAL

Prolapsed Vaginal Ureterocele as a Cause of Urinary Incontinence in a Child

Luca Landi,1 Antonio Elia,1 Ottavio Adorisio2*

A 5-year-old child was referred to our department with a clinical history of urinary incontinence, dysuria and urinary tract infections. Physical examination (abdomen and genitalia) was unremarkable. Abdominal ultrasonography revealed the presence of a left duplicated system (Figure 1A) with normal bladder (Figure 
1B). Antenatal history was unremarkable. Magnetic resonance imaging of the abdomen and pelvis was performed in 
order to clarify the anatomy of the duplicated system (Figure 2). Voiding cystourethrography showed no vesicoureteral 
reflux (Figure 3) while renal scan showed a poor function of the upper pole. As the patient was complaining of urinary 
leakage and dysuria, transvaginal voiding vaginoscopy/urethroscopy was performed. Vaginoscopy demonstrated the 
presence of a cystic mass on the left-anterior vaginal wall (Figure 4). A 3 French ureteral catheter was inserted and an 
un-roofing of the ureterocele was performed, followed by a left hemi-nephroureterectomy of the upper pole because 
of its poor function. 
In most of reported cases, an interlabial mass is usually evident,(1) conversely, in our case, physical examination 
was normal and a correct assessment of the anatomical defect was obtained only with endoscopic investigation. 
Approximately 80% of ectopic ureteroceles are associated with the upper pole moiety of a duplex system leading often 
to urinary retention. Conversely, in this case, urinary incontinence was present.(2,3) For this reason, a vaginal prolapsed 
ectopic ureterocele, despite its rarity, would be considered, as a cause of urinary leakage in a child, especially when 
radiological imaging is not confirmative. In this situation performing cystoscopy/vaginoscopy is essential in order to 
make accurate diagnosis.

1 Department of Pediatric Surgery, Pediatric Urology Unit, Anna Meyer Children’s Hospital, Florence, Italy
2 Department of Pediatric Surgery, Bambino Gesù Children’s Hospital, Rome, Italy.
*Correspondence: Department of Pediatric Surgery, Bambino Gesù Children’s Hospital, Research Institute, via della Torre di Palidoro, 
00050, Passoscuro Rome, Italy.
Tel: +39 06 68593373. E-mail: odomenico.adorisio@opbg.net. 
Received June 2014 & Accepted December 2014.

Figure 1. (A) Ultrasound showing left kidney; (B) Ultra-
sound picture of the bladder.

Figure 3. Voiding cystourethrography. Figure 4. Vaginoscopy showing the ectopic prolapsed vag-
inal ureterocele.

Figure 2. Magnetic resonance imaging demonstrates the 
presence of a left duplicated collecting system (upper pole, 
bold arrow; lower pole, narrowed arrow; white circle, pre-
sumptive insertion of the duplicated system into the bladder 
without evidence of the ectopic prolapsed ureterocele).

Pictorial   1999



Vol 12. No 01   Jan-Feb 2015   1995Vol 12. No 01   Jan-Feb 2015   2000

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Prolapsed Vaginal Ureterocele-Adorisio et al