THE ELUSIVE ECTOPIC URETEROCELES

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Abstract
1. A classification of ectopic ureteroceles, modified from Stephens’ classification by the addition of 1 category is presented. 2. Stephens’ theory of the embryology of ectopic ureteroceles is the only currently adequate theory. 3. Ectopic ureteroceles seen on roentgenograms may display features other than those commonly associated with them. They are consequently difficult to diagnose. 4. The roentgenologic appearance of ectopic ureteroceles may change at any time during the examination because of unpredictable dynamic factors. 5. The excretory urogram is the most useful examination for diagnosing ectopic ureteroceles. Voiding cystourethrograms, however, should also be done to illustrate pathology not seen on the excretory urogram. 6. A full-length roentgenogram should be taken 3-5 minutes after contrast medium injection, before osmotic diuresis has caused the patient to void. 7. Whenever an ectopic ureterocele cannot be ruled out, but cannot be seen on conventional roentgenograms, steep oblique or lateral projections of the bladder should be obtained. Occasionally, a Chassard-Lapine view will also be helpful. 8. When no direct evidence for ectopic ureteroceles exists, the radiologist should ascertain whether or not any indirect evidence exists: change in the axis of the kidney, for example, or in the course of the ureter, or an increase in thickness in the renal parenchyma in the upper pole. 9. The radiologist should search for evidence of ectopic ureteroceles whenever there is, in females or males, a history of recurrent urinary tract infection.

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