Unexplained Lower Abdominal Pain In Cystic Urinary Bladder Tumor

A 19-year-old young man presented due to an intermittent feeling of pressure in the right lower abdomen and reduced urinary stream. With the exception of an incidental finding of right-sided renal agenesis in infancy, the patient had no history of pre-existing diseases or recurrent urinary tract infection. While urinalysis was normal, an intravesical fluid-filled mass was found on ultrasound. Magnetic resonance imaging also showed a cystic structure and identified a blind-ending right ureteric bud and known renal agenesis. Right-sided protrusion of the bladder mucosa and non-identification of the ureteric orifice was striking on cytoscopy. This was incised, upon which urine emptied in a projectile manner. The upper margin of the utereric orifice could then be identified. All symptoms resolved after removal of the catheter the following day. Ectopic ureterocele was the cause of symptoms. This involves dilatation of the intravesical ureter and is frequently associated with duplex kidney system. If ectopic, the ureterocele is located caudal to the actual ureteric orifice and can lead to difficulties with micturition. Recurrence is rare following successful surgery.

Figure

Ultrasound image of the fluid-filled urinary bladder (red star) and cystic mass (crosshairs) at the base

Dr. med. Jens Rosellen, Prof. Dr. med. Joachim Steffens, Klinik für Urologie und Kinderurologie, Sankt-Antonius-Hospital Eschweiler, [e-mail]

Conflict of interests: The authors state that there are no conflicts of interest.

Translated from the original German by Christine Rye.

Cite this as: Rosellen J, Steffens, J: Unexplained lower abdominal pain in cystic urinary bladder tumor. Dtsch Arztebl Int 2020; 117: 782. DOI: 10.3238/arztebl.2020.0782