Ureter

Question 1

Best scan of choice to look for a stone in the ureter?

Answer 1

CT non-contrast

Question 2

Describe the “soft-tissue rim sign” for ureterolithiasis:

Answer 2

adjacent, surrounding soft tissue associated with ureteral edema from an impacted stone

Question 3

Describe the “Comet tail sign”:

Answer 3

adjacent, irregular tapering of soft tissue mass that is from a non-calcified vein associated with phleboliths

Question 4

What is the Weigert-Meyer Rule?

Answer 4

It is the rule regarding a duplicated system of the kidneys (two ureters).

The upper pole ureter inserts the bladder inferior-medially, while the lower pole inserts the bladder superior-laterally

Question 5

In regards to the Weigert-Meyer Rule, which pole is more commonly obstructed, and which one more commonly refluxes?

Answer 5

Upper pole -> inserts inferior-medially usually with an associated ureterocele that obstructs (therefore, upper pole hydronephrosis)

Lower pole -> inserts superior-laterally and refluxes

Question 6

In regards to the Weigert-Meyer Rule, which pole is most commonly associated with an ectopic ureter?

Answer 6

The upper pole

Question 7

Best imaging modality to ID an ectopic ureter?

Answer 7

MRI

Question 8

Describe the course of a retrocaval ureter:

Answer 8

The right ureter courses posterior and medial to the IVC, then crosses anterior to the IVC while coursing laterally towards the common iliac bifurcation.

Question 9

What is the etiology of a retrocaval ureter?

Symptoms?

Treatment?

Answer 9

Etiology: persistent right subcardinal vein (anomaly of the IVC, not the ureter!!!)

Symptoms: flank pain (due to obstruction/hydronephrosis), UTI’s, or asymptomatic

Treatment: ureteroureterostomy with removal of retrocaval portion (it is usually aperistaltic)

Question 10

Describe the “Drooping Lily sign”:

Answer 10

hydronephrotic nonfunctioning upper pole displaces the opacified, functioning lower pole inferiorly, thus appearing like a drooping lily

Seen in duplicated systems

Question 11

What is “Ormond’s disease?”

What position are the ureters in compared to normal?

Answer 11

Retroperitoneal fibrosis

Medial deviation of the ureters

Question 12

What is the “Goblet sign?”

Answer 12

Ureteral dilation just DISTAL to a ureteral TUMOR, giving an appearance of a goblet

*ureteral calculi cause distal ureteral spasm

Question 13

The right or left ureter is more commonly affected by pregnancy associated hydroureter?

Answer 13

Right > left

Question 14

Around which weeks is pregnancy associated hydroureter most prominent?

Answer 14

22-24 weeks

Question 15

Etiology of pregnancy associated hydroureter?

Answer 15

1) Gravid uterine compression

2) High progesterone causes smooth muscle relaxation

Question 16

What is the “Cobra-head deformity” or “spring-onion sign?”

Answer 16

IVP or CT with contrast shows a thin wall of an uncomplicated adult ureterocele separating ureteral and bladder contrast

On US, appears as a “cyst within a cyst”

Question 17

In a duplicated system, which moiety is associated with a ureterocele?

Answer 17

Upper pole (the ectopic moiety; inserts inferior-medially)