Comment on: Prolapse of a single-system ureterocele causing urinary retention in an adult woman

Dear Editor, We read the article by Drs Westesson and Goldman with interest [1]. They reported a case of pelvic pain and a bulge from the urethra. After physical examination and radiological evaluation, the diagnosis of prolapse of a single system ureterocele was made. No stone was documented in the ureterocele sac. The ureterocele was successfully incised and excised with the aid of cystoscopy. We saw a 34-year-old woman who presented with dysuria and right-sided flank pain for 6 months. Urinalysis and urine culture revealed bacteriuria and microscopic hematuria. On plain X-ray, radio-opacity suggestive of right distal ureter was observed (Fig. 1). Blood biochemical analysis was normal. Abdominopelvic ultrasound examination confirmed 1x1-cm calculus in a single-system ureterocele. In addition, mild right hydroureteronephrosis was noticed. Cystoscopy was performed and demonstrated a right-sided ureterocele. The patient underwent a ureterocele incision along its inferolateral border (Fig. 2). The incision was performed using a Collings knife. The cutting current level was set low in order to provide a clear incision. Moderate bladder distention was maintained to better make a low and short incision. This low and short smiling incision technique preserves the flap valve ureteral antireflux mechanism. because when the roof of the ureterocele collapsed, it formed a valve to prevent reflux. Since the stone was not very big, it was extracted and removed easily. We think that the low and short smiling incision technique with use of a Collings knife provides adequate drainage in the upper urinary tract, decompresses the ureterocele, and prevents reflux. For bigger stones, the stone may be fragmented in the ureterocele sac, and small