Ureteral ectopia


Ureteral ectopia

Description, Causes and Risk Factors:

Ureteral ectopia is a congenital abnormality of the terminal segment of one or both ureters in which the ureteral orifice is located at a site other than the trigone of bladder.

This anomaly is commonly associated with continuous or intermittent urinary incontinence. Ureteral ectopia is often present in combination with other urinary abnormalities, such as hydroureter, hydronephrosis, pyelonephritis, bladder hypoplasia, and the presence of an intrapelvic bladder neck associated with a short urethra. To date, ureteral ectopia combined with renal dysplasia and urolithiasis has not been documented.

More than 80% of ureteral ectopia are associated with an ureteral duplication, especially in girls. In girls, the ureteral ectopia drains into the urethra (35%), vulval vestibule (34%), vagina (25%) or uterus (5%). In boys, the ureteral ectopia drains into the prostatic urethra (47%), seminal vesicles (33%), prostatic utricle (10%) or vas deferens (10%).

The further the distance of the ureteral opening from its normal position, the higher the likelihood of a renal malformation (renal dysplasia, renal hypoplasia) and dysfunction. If the ureteral ectopia is associated with a duplex system, the ureteral ectopia drains the upper pole of the kidney.

The disease is more common in blacks than whites and high prevalence in females.

Symptoms:

Recurrent urinary tract infections, flank pain, fever. Additionally and depending on gender and location of the ureteral orifice:

    Girls: urinary incontinence (day and night, but sometimes also intermittent), vaginal discharge.

  • Boys: lower urinary tract symptoms, epididymitis.

Diagnosis:

    Pelvic examination is indicated in girls with urinary incontinence, sometimes the orifice of the ureter can be identified in the vagina or vulval vestibule.

  • Cystoscopy and retrograde pyelography to search for ureteral orifices.

  • Ultrasound imaging:Ureteral ectopia may cause hydronephrosis. If a duplex kidney is present, urinary obstruction of the upper kidney portion may be visible. A dilated ureter may be detectable behind the bladder.

  • MRI urography is the most accurate imaging tool and indicated for imaging in children, especially if unclear findings in previous investigations are present and an ectopic ureter is suspected. CT is an imaging alternative in adults which is more sensitive compared to intravenous urography.

  • Intravenous urography is increasingly replaced by MR urography or in adults by CT. Urography often lacks to image in the upper part of the duplex kidney due to poor renal function. Hints for a non-contrasting upper portion is obtained from the small number of calices shown and the greater distance of the renal system to the spine. Late images after 1-3 hours may however contrast the upper renal portion.

  • Voiding cysturethrography (VCUG) may detect reflux into the lower renal pole, if a duplex kidney is present.

  • Renal scintigraphy is indicated to determine the renal function on the side of the ectopic ureter. If a duplex system is present, the renal function of the upper and lower pole must be analyzed separately.

Treatment:

The treatment for ureteral ectopia is surgery. To control the risk of infection, the patient may be placed on a low-dose of antibiotics prior to surgery. While there are two surgical techniques — ureteropyelostomy and ureteral re-implantation — to correct this problem, each has advantages and disadvantages. It is advisable to discuss the best treatment/surgical options by your physician/surgeon.

Ureteral ectopia with a nonfunctioning kidney: Hemi-nephrectomy for a duplex kidney (upper pole partial nephrectomy) or nephrectomy in a single system, surgery is possible with laparoscopy. If reflux is present into the ureteral ectopia, ureterectomy is also necessary. If significant vesicoureteral reflux is present into the lower pole of a duplex kidney, ureterocystoneostomy of the lower pole ureter is necessary.

Ureteral ectopia with sufficient renal function: Common sheat ureteroneocystostomy (UCN) for a duplex kidney with closely spaced ureteral orifices. Ureteropyelostomy or ureteroureterostomy for a duplex kidney and widely spaced ureteral orifices. If reflux into the ureteral ectopia is present, resection of distal ectopic ureter is necessary. Ureteroneocystostomy (UCN), if the ureter drains a single renal system.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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