Bilateral Obstructing Ureteroceles Presenting As Hypertension in a Young Adult Without Urinary Symptoms: A Case Report.

We present a 35-year-old man with long-standing untreated hypertension who had no urinary symptoms, flank pain, or history of urinary tract infections and was later found to have bilateral ureteroceles with bilateral hydronephrosis and renal cortical thinning. A ureterocele is a congenital cystic dilation of the distal ureter as it inserts into the bladder that can impede urinary drainage. The initial laboratory workup for secondary hypertension was unremarkable, and he had a minimal response to first-line blood pressure management. Imaging was then sought to evaluate for structural causes of secondary hypertension, which ultimately revealed the bilateral ureteroceles. This case represents only the second reported instance of bilateral ureteroceles discovered during evaluation for secondary hypertension in an adult. The absence of classic urological symptoms despite significant obstructive uropathy emphasizes the importance of maintaining a broad differential diagnosis when evaluating hypertension in young adults. Structural urological abnormalities, including congenital anomalies, should be considered, as they may represent potentially reversible causes of secondary hypertension.