Ureteral Pseudodiverticulosis

Ureteral pseudodiverticulosis refers to the presence of multiple small (< 4 mm in diameter) outpouchings along the ureters. There is bilateral involvement in about 70% of cases, and the upper and middle thirds of the ureters are involved in about 85% of cases. The pouches are made up of hyperplastic ureteral epithelium that partially protrude into the muscular layer of the ureter wall.

Ureteral pseudodiverticulosis is most commonly associated with chronic infection or inflammation, among other urinary tract pathologies, and occurs most commonly in older patients. There is an association with malignancy; therefore, close follow-up is recommended.

On urography, ureteral pseudodiverticulosis may appear as a few separate well-developed outpouchings or as closer, poorly developed ones.

Retrograde urography may allow better distension and visualization of pseudodiverticula. Post-drainage images may allow even better visualization due to stasis of contrast material in the pouches.

References

Wasserman NF, La Pointe S, Posalaky IP. Ureteral pseudodiverticulosis. Radiology. 1985 Jun;155(3):561-6.