Spectrum of ectopic ureters in children

Abstract

We reviewed the clinicopathological features, diagnosis, and surgical treatment of ectopic ureters (EU) in children in order to evaluate the anatomy, renal function, outcome, and the existence of any racial or regional difference in this abnormality. The records of 27 consecutive patients with 33 EU managed over a period of 7 years were analyzed. There were 25 female and two male patients. Their age ranged from 1 to 13 years, with an average of 4.5 years. The presenting features included history of continuous dribbling of urine with otherwise normal voiding in toilet-trained female patients, incontinence of urine, urinary tract infection, abdominal pain, and renal failure. The diagnostic work-up included ultrasonography (US) in all 27 patients, intravenous pyelography (IVP) in 23, micturating cystourethrogram (MCU) in 19, nuclear imaging (NI) in 16, and computed tomogram (CT) in five patients. All patients underwent examination under anesthesia (EUA) and cystourethrovaginoscopy immediately before the operation. Single-system ectopic ureter (SSEU) was present in 19 patients with 25 ureters (six bilateral), and duplex with ectopic ureter was present in eight cases. The left side was involved in 14 cases, the right side in seven, and the anomaly was bilateral in six cases. Abnormalities noted in the imaging studies were USG 23/27, IVP 23/23, MCU 11/19, NI 13/16, and CT 5/5 cases. EUA and cystourethrovaginocsopy helped in localization of the ectopic site and evaluation of the bladder. The surgical treatment included nephroureterectomy (NUT) for non-functioning kidney in 7 patients, heminephroureterectomy (HNUT) for non functioning upper pole of duplex kidney with EU in 6 patients, ureteric reimplantation (UTR) in 13 patients (19 ureters, 6 bilateral), and ureteropyelostomy (UTP) in one patient. In the follow-up period ranging from 1 to 5 years, 20 patients achieved continence; however, six cases with bilateral SSEU and one case of unilateral SSEU, who also had a patulous bladder neck, continued to dribble urine. SSEU was more common than duplex with ectopic ureter. A large number of functioning renal units associated with SSEU deserved preservation. The success of surgical treatment in terms of achievement of continence was high and depended on the integrity of the bladder neck.

H-type rectovaginal fistula in a patient with bilateral single ectopic ureters

“…The second mechanism, proposed by Stephens and Donnellan, is that the developing septum separating the rectum and the urethra is misaligned with the anus and results in failure to completely obliterate the cloaca [9]. Interestingly, the most common accepted embryologic cause for ectopic ureters is also misalignment of migrating tissues, the ureteric bud, and bladder [10]. Although a common mechanism relating Htype anorectal malformations and bilateral single ectopic ureters is not understood, certainly in addition to this case, urologic problems accompanying anorectal malformations have frequently been reported.…”

Postpartum vaginal cystic lesions: everyday practice or a differential diagnosis challenge?

“…The therapeutic approach in patients with a single system in which the kidney is usually dysfunctional and the base of the bladder (hemitrigone) is poorly developed treatment usually consists of nephrourecterectomy. If the kidney is functional, the treatment is resection of the distal ectopic ureter and re-implantation into the bladder [17,18]. …”

Duplicaciones del tracto urinario

“…El grado de la obstrucción es variable y puede oscilar entre una obstrucción parcial más o menos intensa y una obstrucción total. La técnica quirúrgica de elección para tratar la obstrucción en las duplicaciones pieloureterales se basa en la función del hemirriñón afectado [23][24][25][26][27][28] . Entre las opciones de tratamiento quirúrgico se incluyen la extirpación del hemirriñón afectado, la anastomosis uretero-ureteral o pielo-ureteral, la reconstrucción de la vía urinaria baja mediante la reimplantación vesicoureteral del doble sistema con o sin remodelaje de la vía urinaria, el tratamiento endoscópico del reflujo vesicoureteral y la punción endoscópica del ureterocele.…”