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Ureters

Congenital abnormalities


Reviewers: Sean Williamson, M.D., (see Reviewers page)
Revised: 13 July 2012, last major update May 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

General
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Diverticula:
● Congenital diverticulum results from aberrant development of ureteric bud (true diverticulum including all layers of normal ureter wall)
● Pseudo-diverticulum results from mucosal protrusion through a defect in the ureter wall (due to instrumentation, surgery, stone, obstruction, etc)
● Can be asymptomatic or cause recurrent urinary tract infections
● Lined by urothelium, sometimes squamous metaplasia or ureteritis glandularis

Double/bifid ureters
● Relatively common incidental finding, associated with duplication of renal pelves

Hydroureter:
● May have neurogenic cause

Megaloureter (megaureter):
● Often divided into primary obstructed and primary refluxing megaureter
● May have smooth muscle defect (such as apoptosis of smooth muscle in primary obstructive cases)
● Defective interstitial cell of Cajal-like cells have been hypothesized to be involved in refluxing cases (Urology 2009;74:318)

Ureteropelvic junction obstruction:
● One of the most common causes of hydronephrosis in children
● More common in males and on left side, 20% bilateral
● May be associated with agenesis of contralateral kidney
● May be due to abnormal organization of smooth muscle bundles (intrinsic obstruction thought to be associated with less dense muscle and increased collagen, compared to obstruction due to crossing of renal vessel, Urology 2010;76:181)

Gross images
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Incidental double ureter identified at surgery

End of Ureters > Congenital abnormalities


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