The RS score (Richter syndrome score), which is an estimate of the patients prognosis, is based on the patients performance status, LDH, platelet count, the size of the lymphoma tumors, and the number of prior therapies already received. Overall, the median survival is between five and eight months. Untreated, RS is invariably fatal. The Hodgkins lymphoma variant of Richters carries a better prognosis than the predominant diffuse large B-cell lymphoma type, but a worse prognosis than a de novo case of Hodgkins. Epidemiology
A SEER-based analysis estimated the risk of Richters transformation in Chronic Lymphocytic Leukemia (CLL) patients in the United States to be about 0.72%. The majority of transformations (85%) were Diffuse Large B-Cell Lymphoma (DLBCL), while transformation to Hodgkin occurred in 15% of cases. Most of those transformation events were nodal (74%). The most commonly involved extra-nodal sites were the GI tract (25%), skeletal system (19%), and the brain/CNS (12%). The median time from the diagnosis of CLL to the development of Richters transformation was about 4 years, with no significant difference in the time interval based on histology of the transformation event comparing DLBCL and Hodgkins. The median age at the time of Richters transformation was 66 years. References
Further reading
Tsimberidou AM, OBrien S, Khouri I, Giles FJ, Kantarjian HM, Champlin R, Wen S, Do KA, Smith SC, Lerner S, Freireich EJ, Keating MJ (May 20, 2006). "Clinical Outcomes and Prognostic Factors in Patients With Richters Syndrome Treated With Chemotherapy or Chemoimmunotherapy With or Without Stem-Cell Transplantation". Journal of Clinical Oncology. 24 (15): 2343–2351. doi:10.1200/JCO.2005.05.0187.
A ureterocele is a congenital abnormality found in the ureter. In this condition the distal ureter balloons at its opening into the bladder, forming a sac-like pouch. It is most often associated with a duplicated collection system, where two ureters drain their respective kidney instead of one. Simple ureterocele, where the condition involves only a single ureter, represents only twenty percent of cases. Since the advent of the ultrasound, most ureteroceles are diagnosed prenatally. The pediatric and adult conditions are often found incidentally, i.e. through diagnostic imaging performed for unrelated reasons. Classification
Intravesical
Confined within the bladder
Ectopic
Some part extends to the bladder neck or urethra
Stenotic
Intravesical ureterocele with a narrow opening
Sphincteric
Ectopic ureterocele with an orifice distal to the bladder neck
Sphincterostenotic
Orifice is both stenotic and distal to the bladder neck
Cecoureterocele
Ectopic ureterocele that extends into the urethra, but the orifice is in the bladder

Signs and symptoms
The signs and symptoms of ureterocele in the latter two forms can easily be confused with other medical conditions. Symptoms can include:
Frequent urinary tract infections
Pyelonephritis
Obstructive voiding symptoms
Urinary retention
Failure to thrive
Hematuria
Cyclic abdominal pain
Urolithiasis
Cobra head sign is seen in radiography
In females: salpingitis, hydrosalpinx with sepsis or torsion. T.O. mass. Complications
Many other complications arise from ureteroceles. Redundant collection systems are usually smaller in diameter than single, and predispose the patient to impassable kidney stones. The effective "bladder within a bladder" compounds this problem by increasing the collision of uric acid particles, the process by which uric acid stones are formed. Ureterocele is also associated with poor kidney function.