Vaginal ectopic ureter diagnosed by magnetic resonance imaging in a child with complete transverse vaginal septum and hydrocolpos

Abstract

Ectopic ureter draining into the vagina is a rare cause of urinary incontinence. Some cases have been reported in association with malformations of the genitourinary tract, but very few published cases are associated with vaginal septum. Our article describes the case of a girl who presented with hydrocolpos shortly after birth and was found to have a complete transverse vaginal septum. Despite successful correction of this genital anomaly, the patient developed persistent dribbling of clear fluid from the genital area. Extensive testing revealed unilateral kidney dysplasia and probable genital ectopia of the corresponding ureter. Magnetic resonance imaging (MRI) showed insertion of the ureter into the upper third of the vagina. The patient underwent nephroureterectomy of the dysplastic kidney with subsequent improvement in urinary incontinence. Ureteral ectopia is difficult to diagnose with conventional imaging methods (plain radiography, ultrasound, and CT). MRI has proved to be an excellent method for assessment of genitourinary tract conditions, particularly when other diagnostic modalities have failed or are limited, due to the high resolution of MRI scans and the possibility of native image acquisition on all three orthogonal planes. MRI is the best diagnostic modality for visualization of the course and insertion of ectopic ureters, and enables precise surgical correction. Keywords: Congenital vaginal ectopic ureter; magnetic resonance imaging; hydrocolpos CASE REPORTA 4-year-old girl presented with a history of intermittent leakage of clear fluid from the genital region. Shortly after birth, she developed a large hydrocolpos causing bilateral ureterohydronephrosis and lower limb edema, and was diagnosed with transverse vaginal septum and a multicystic dysplastic and ectopic right kidney (renal pelvis). On that occasion, drainage and placement of a uterine stoma improved venous and urinary flow. At 10 months, open correction of the vaginal septum and closure of the uterine stoma were performed. After this procedure, the patient developed intermittent dribbling of clear fluid, identical in appearance and odor to urine, from the genital area.A wide variety of diagnostic tests (including ultrasound, computed tomography [CT], cystoscopy, and vaginoscopy) were performed, but failed to confirm the hypothesis of ectopic ureter draining the dysplastic right kidney. At the age of 3, the patient was found to have frequent dribbling of urine during diaper changes despite adequate sphincter control. Physical examination revealed passage of fluid droplets through the vaginal introitus, and she was referred for further radiological assessment. A radionuclide kidney scan showed 48% renal function on the left and complete absence of right kidney function. Dynamic ultrasound examination of the bladder revealed a small amount of fluid in the vagina, which did not coincide with urge to urinate or with recent voiding. Transperineal color Doppler imaging showed discharge of urine into the vagina, suggesting right kidn...

Novel approach to locating a hypoplastic kidney in a unique variant of uterine didelphys syndrome presenting with continuous incontinence

“…CT with IVP can be useful in assessing atypical renal tracts, however is often passed by in favour of other modalities given the very young age of most patients. MRI has been emphasised as a beneficial modality in clarifying anatomical variation in this situation 2 6 12 14. Joshi et al described seven cases of congenital renal dysplasia with single system ureteral ectopia diagnosed preoperatively with MR urography with 100% sensitivity and specificity for confirmation of renal dysplasia and characterisation of ureter course 14.…”

“…MRI has been emphasised as a beneficial modality in clarifying anatomical variation in this situation 2 6 12 14. Joshi et al described seven cases of congenital renal dysplasia with single system ureteral ectopia diagnosed preoperatively with MR urography with 100% sensitivity and specificity for confirmation of renal dysplasia and characterisation of ureter course 14. However, MRI has not been able to facilitate diagnosis of ureteral ectopia with renal hypoplasia in other reported cases.…”