Incidentally Discovered Ureterocele in a Patient Undergoing Sacrospinous Ligament Suspension: What Surgeons Should Know About This Uncommon Entity

INTRODUCTION: Ureteroceles are cystic dilatations of the terminal ureter, occurring in 1 in 500 to 1 in 4,000 individuals. They are four to six times more common in females. Intravesical ureteroceles, located entirely within the bladder, are the most common type seen in adults. The most accepted explanation of intravesical ureterocele formation is incomplete canalization of the ureteral bud during embryogenesis. In adults, ureteroceles are often asymptomatic and are discovered incidentally during ultrasound, CT, or cystoscopy. When symptomatic, recurrent urinary tract infections are the most common presentation, although in 5–10% of cases urethral prolapse can occur, which can present as a vulvar mass with urinary symptoms. OBJECTIVE: This video aims to present a case of an incidentally discovered ureterocele and discuss the pathophysiology, diagnosis, and management of this finding. METHODS: We describe the case of a 61-year-old G1P1 status post hysterectomy who presented with pelvic organ prolapse, who underwent sacrospinous ligament fixation and posterior colporrhaphy. A unilateral orthotopic ureterocele was identified during cystoscopy. RESULTS: The video demonstrates the characteristic appearance of a ureterocele on cystoscopy, presenting as a bulge near the ureter that balloons out as it fills with urine and decompresses when urine passes through the ureteral orifice. CONCLUSIONS: Gynecologists who have adopted the practice of performing cystoscopy after major gynecologic surgery may encounter incidental ureteroceles. This video describes the appropriate management and workup of ureteroceles, so gynecologists are better prepared when they identify this uncommon entity.