Pipestem Ureter

This pipestem megaureter is a dilated ureter

without an overt obstructing lesion.(see Fig. 1.10)

Two basic types exist. These are the refluxing

and non-refluxing types. The refluxing type is

associated with gross reflux and is rarely seen.

The non-refluxing type is by far the most com-

mon type seen and here the functional abnor-

mality appears to be in the terminal ureter. The

exact nature of this functional abnormality is

not known – but three points are well estab-

lished. These are:

1. That there is no absence of ganglion cells in

the terminal portion of the ureter.

2. The cause is thought to be due to a dispro-

portion of circular and longitudinal muscle

fibers in the terminal ureter.

3. That normal peristaltic contraction waves do

not pass through this terminal portion of the

ureter.

Figure 1.9. X-ray of large ureterocele with halo sign.

female, may produce extremely difficult diag-

nostic problems. This is particularly true when

they are so large as to almost completely fill the

bladder, making cystoscopic observation diffi-

cult and confusing. Large ureteroceles may

obstruct the vesical neck and even prolapse

through the urethra in females. In adults, ure-

teroceles tend to be bilateral and smaller, thus

causing less obstruction and thus fewer symptoms.

In males they are often found co-incidentally at

time of cystoscopy done prior to transurethral

resection of the prostate (TURP) and should be

noted so as not to be post operatively related to

the resection. The clinical history and clinical

findings are related to obstruction and stasis

and if symptomatic, the treatment is surgical.

Congenital Ureteral Obstruction

Congenital ureteral obstructions are our next

topic of discussion. I will allude to three such

types of obstruction and the first of these is the

“pipestem” or classic megaureter.

Figure 1.10. Pipestem ureter.