URETEROCELE EVERSION WITH VESICOURETERAL REFLUX IN DUPLEX KIDNEYS - FINDINGS AT VOIDING CYSTOURETHROGRAPHY

OBJECTIVE. Ureterocele eversion refers to the sudden appearance of a b ladder diverticulum at the site of ureterocele compression during void ing cystourethrography (VCUG). The radiologic appearance closely resem bles a congenital bladder (paraureteral) diverticulum. Distinguishing ureterocele eversion with vesicoureteral reflux in duplex kidneys from congenital bladder diverticula with reflux is important for preoperat ive planning. This study describes the findings of ureterocele eversio n and lower pole vesicoureteral reflux in duplex kidneys on VCUG and d emonstrates how its appearance can be misleading. MATERIALS AND METHOD S. Medical records, sonograms, and cystograms were reviewed retrospect ively for 12 children who had VCUGs demonstrating bladder diverticula with vesicoureteral reflux and who, at surgery, had ureteroceles assoc iated with duplex systems. Each case was assessed as to whether the fi nding of a diverticulum with reflux on VCUG had been correctly interpr eted as ureterocele eversion with lower pole vesicoureteral reflux. RE SULTS. Diagnosis of ureterocele eversion with lower pole reflux was un certain or misinterpreted as congenital bladder diverticula with reflu x in five patients in whom ureteroceles were not identifiable or in wh om reflux occurred into what resembled single systems rather than lowe r poles of duplex systems, In two patients in whom ureteroceles were n ot initially identified, fluoroscopy recognized ureterocele eversion w ith lower pole reflux. Sonography confirmed ureterocele in one of thes e patients, and cystoscopy in the other. CONCLUSION. Ureterocele evers ion with lower pole vesicoureteral reflux is readily diagnosed by VCUG when a ureterocele is initially identified or if the fluoroscopic app earance 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 initiall y detected or if the refluxed system is not recognized as a lower pole moiety.