Vaginal Insertion of Ectopic Ureter Diagnosed in Adulthood, the First Case in Bosnia and Herzegovina

Abstract

An ectopic ureter is defined as a ureter that does not insert into the normal anatomical position. The occurrence of ectopic ureters is 1/2,000 in newborns and 1/2,000–4,000 in the general population. In most cases the ectopic ureter is associated with a duplicated renal collecting system, while in 20% a single system is found. The majority of cases are diagnosed during childhood as a result of continuous urinary dribbling or recurrent urinary tract infections. In ectopic ureteral openings, diagnosis is often delayed because of inadequate evaluation; in addition, most diagnostic methods do not provide sufficient information about ectopic ureteral openings. In this particular case, we report on a patient with urinary incontinence and frequent episodes of urinary infections. In her childhood, she exhibited enuresis and was examined by a psychiatrist, followed by a neurologist and a gynecologist. CT urography revealed mainly hydronephrosis of the upper pole of the right kidney and a duplicate ureter on the right side, but not duplicate ureter insertion. Percutaneous nephrostomy was performed, with insertion of methylene blue into the collecting system. After the clinical investigation of the vagina with a speculum, a was observed blue dot at the vaginal fornix. Right partial upper pole nephrectomy and ureterectomy were performed. An ectopic ureter opening is a clinical entity, rarely observed in a small country such as Bosnia and Herzegovina, but should be kept in mind during clinical evaluation of patients with incontinence, irrespective of the patient’s age.