Abdominal Radiology

, Volume 44, Issue 7, pp 2676–2676 | Cite as

Clinical evaluation of ureteral pseudodiverticulosis

  • Kenji YoritaEmail author
Letter to the Editor

To the Editor,

I read the recent paper on ureteral pseudodiverticulosis (UPD) cases by Morgan et al. [1]. I am interested in the accumulation of UPD cases in their study, as they did not mention the size of pseudodiverticula.

A ureteral diverticulum is a rare entity. In 1947, Culp [2] classified ureteral diverticula into the following two types: congenital (true) and acquired (false). The former is a large, dilated, blind-ended protrusion of the entire wall, and the latter is a large protrusion of the mucous epithelium through the muscular layer. As excretory and retrograde urography became popular, many cases of small, multiple ureteral outpouchings were identified, and this condition might not be unusual, as its incidence was reported to be 11% in a study of 100 postmortem cases [3]. These multiple ureteral outpouchings have been referred to as multiple ureteral diverticula [4], ureteral diverticulosis [5], and UPD [3, 6]. Wasserman et al. [3] performed a detailed clinicopathological study on multiple ureteral outpouchings and called the condition UPD, as it could not be considered in the classification proposed by Culp [2]. The authors noted that multiple ureteral outpouchings of UPD are small, do not involve the entire wall of the ureter, and consist of non-neoplastic hyperplastic urothelium that invaginates into the ureteral lamina propria and does not penetrate the proper muscle [3]. The term UPD may have been exclusively used for such a condition; however, as UPD is a clinicopathological term, attention should be paid to the accumulation of UPD cases, when UPD is considered without histological evaluation. Di Paola et al. [7] reported a case of UPD with the size ranging from 3 to 6 mm on retrograde pyelography; however, the microscopic photograph of one of the outpouchings showed the invaginated epithelium penetrating the muscularis propria, which cannot be referred to as UPD according to the study by Wasserman et al. [3, 6]. As Wasserman et al. reported that outpouchings of UPD were 4 mm or less in diameter, larger ureteral outpouchings may not be considered in UPD. It is preferable for UPD to be defined by small, multiple ureteral outpouchings 4 mm or less in diameter when UPD is clinically evaluated. In addition, as UPD can be detected by multidetector computed tomography [8], it may be useful to confirm that outpouchings do not lead off from the ureteral wall on multidetector computed tomography in order to rule out the possibility of diverticulum as defined by Culp [2].


Compliance with ethical standards

Conflict of interest

The author states that there is no conflict of interest or funding source.


  1. 1.
    Morgan MA, Chua WY, Zafar HM, Papanicolaou N, Ramchandani P (2019) Ureteral pseudodiverticulosis and urothelial cell carcinoma: rethinking the association. Abdom Radiol (NY) 44:234-238CrossRefGoogle Scholar
  2. 2.
    Culp OS (1947) Ureteral diverticulum classification of the literature and report of an authentic case. J Urol 58:309-321CrossRefGoogle Scholar
  3. 3.
    Wasserman NF, Posalaky IP, Dykoski R (1988) The pathology of ureteral pseudodiverticulosis. Invest Radiol 23:592-598CrossRefGoogle Scholar
  4. 4.
    Holly LE 2nd, Sumcad B (1957) Diverticular ureteral changes; a report of four cases. Am J Roentgenol Radium Ther Nucl Med 78:1053-1060Google Scholar
  5. 5.
    Lester PD, Kyaw MM (1973) Ureteral diverticulosis. Roentgenologic manifestation of ureteritis. Radiology 106:77-80Google Scholar
  6. 6.
    Wasserman NF, La Pointe S, Posalaky IP (1985) Ureteral pseudodiverticulosis. Radiology 155:561-566CrossRefGoogle Scholar
  7. 7.
    Di Paola G, Mogorovich A, Manassero F, Ali G, Selli C (2009) Pseudodiverticula of ureter: radiologic and histologic findings. Urology 73:268-269CrossRefGoogle Scholar
  8. 8.
    Spalluto LB, Woodfield CA (2009) Ureteral pseudodiverticulosis: a unique case diagnosed by multidetector computed tomography. J Comput Assist Tomogr 33:286-287CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Diagnostic PathologyJapanese Red Cross Kochi HospitalKochi-shiJapan

Personalised recommendations