Distal ureter prolapses to the bladder lumen (orthotopic ureterocele). May be incidental or associated with obstruction, infection or stones. Ectopic ureterocele is associated with a duplex system. Always inserts above the external sphincter in males, but in females, it may insert to the vagina or uterus, resulting in incontinence.
• Mass in the bladder lumen adjacent to the VUJ (bladder base if ectopic).
• Look for obstructed upper pole if ectopic (i.e. duplex system).
• ‘Cobra’s head’ appearance on IVU.
• Soft tissue mass on CT, which opacifies in the excretory phase.
IVU showing the characteristic ‘cobra’s head’ appearance of a left ureterocele.
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