Ureteritis: Causes, Symptoms, Diagnosis and Treatment

Ureteritis is a term that refers to inflammation of the ureter, it is a rare condition and is often associated with cystitis or pyelonephritis

It can be qualified into subtype descriptions based on its etiologic factors. For example,

• Postoperative,
• Infective, and
• Noninfective ureteritis.

Noninfective causes include

• Ureteral amyloidosis,
• Eosinophilic ureteritis,
• IgG-4 associated ureteral inflammation, and
• Idiopathic segmental ureteritis

One form is known as "ureteritis cystica. In this condition there cystic transformation of the epithelial nest of Brunn, with the appearance of numerous cysts containing clear fluid with sizes between 1 and 10 mm with flattened epithelial walls.

It is considered the result of irritation in nonspecific chronic inflammations

Ureteritis cystica (UC) is usually suspected when defects of filling are seen in the ureter in contrasted images of the urinary tract

vitamin A excess and increased immunoglobulin A

Ureteritis cystica is an infrequent condition which is predominantly found in adults females,

When present in the bladder they are referred to as cystitis cystica

Pathophysiology

The etiology of ureteritis is most commonly infectious from associated cystitis but there are many causes:

• Ascending urinary tract infections; the most common causative agents are Escherichia coli and Aerobacter aerogenes
• Chronic inflammation secondary to ureteric stents
• Direct spread from adjacent organs (e.g. in appendicitis, diverticulitis, inflammatory bowel disease, etc)
• Haematogenous spread

Clinical presentation

The clinical presentation is variable.

Patients may present with symptoms of cystitis or pyelonephritis with suprapubic/flank pain, dysuria, hematuria and/or fever.

White cell count may also be elevated

Ureteritis cystica is usually detected during the evaluation of urinary tract infections (82%), lithiasis (53%) or haematuria

CT scan shows diffuse, circumferential urothelial wall thickening and contrast-enhancement periureteric or perinephric fat stranding

The most commonly used imaging techniques are excretory urography and retrograde pyelography.

In these imaging studies, one can observe numerous defects of filling with well-defined, rounded smooth contours often with a “scalloping” appearance

Ureteroscopy plays a fundamental roll in the ability to directly visualize cystic formations and to take biopsies in order to realize an anatomopathological analysis.

Treatment of ureteritis

The treatment consists of eliminating the process which is causing the inflammation (infection, lithiasis), although in those cases in which obstruction other measures may be appropriate.