Single Ectopic Ureter Research Articles

Single system ectopic ureters: Adult presentation of a congenital anomaly

Objective:To retrospectively review a cohort of adult patients with single ectopic ureter, a rare congenital abnormality where one ureter terminates in an abnormal position outside of the trigone of the bladder. Methods:We identified 5 patients diagnosed with a single ectopic ureter over a single surgeon’s career over 35 years and 2 institutions. Clinical symptoms, medical history, interventions, available radiologic imaging, and urodynamic features were analyzed. Results:Median age at diagnosis was 53 years (range 18–85 years). The majority were male (80%). All patients were noted to have a solitary functioning kidney. A diminutive contralateral kidney and ureter was found in 1 (20%) patient. All patients were symptomatic, with the most common presenting symptoms being chronic dysuria (60%) and chronic prostatitis (40%). Physical examination findings were identified in 3 (60%) patients. Interventions were principally dependent upon the type and severity of each patient’s symptoms, and included observation, drainage of ectopic structures, vaginal marsupialization, and laparoscopic nephroureterectomy. The 3 (60%) patients that underwent intervention remained symptom free and the 2 (40%) patients that decided on observation were minimally symptomatic. Conclusions:Single ectopic ureter is a complex embryological abnormality that can result in a wide array of anatomic variations and clinical findings in both men and women. Given the rarity of this entity in adult patients, a high index of suspicion must be held by the clinician for this diagnosis. Ultimately, treatment options for these patients will be dependent upon symptom severity, anatomic presentation, and patient quality of life.

A Rare Case of Double-System With Ectopic Ureteral Openings Into Vagina

The presence of an ectopic ureter may be indicated by continuous wetting, despite a normal voiding pattern, especially in girls. In most cases, an ectopic ureter is associated with a duplex collecting system and complete ureteral duplication. A 5-year-old girl presented with urinary incontinence regardless of the successful toilet training and a suspicion of left duplex kidney on a previous ultrasound. Contrast-enhanced computed tomography revealed a double left kidney with double ureters, both inserting together into the vagina. The surgical treatment consisted in the “en block” reimplantation of the ectopic ureters into the bladder, with complete resolution of the symptoms. The reported case does not represent just a typical presentation of a single ectopic ureter, as the duplex kidney system had ectopic both ipsilateral ureters (with insertion into the vagina). This case reminds us that congenital abnormalities of the genito-urinary tract should be considered in case of urinary incontinence and recurrent urinary tract infections.

両側単一尿管異所開口および単腎の単一尿管異所開口症例の検討 : とくに膀胱形成不全に対するstaged operation について

両側単一尿管異所開口および単腎の単一尿管異所開口症例の検討 : とくに膀胱形成不全に対するstaged operation について

Bilateral single system ectopic ureters opening into vestibule with bladder agenesis

Almost 80% of ectopic ureters are associated with duplicated system, and 5-17% of ectopic ureters are bilateral. Ectopic ureters usually open into urethra, vestibule and vagina in females and into posterior urethra and seminal vesicles in males. Bilateral single-system ectopic ureter (BSSEU) is a rare entity in urology. BSSEU opening into a vestibule with the absence of urinary bladder is an extremely rare occurrence. We report such a case and briefly discuss its management.

Bilateral Single Ectopic Ureters Draining Into a Grossly Dilated Vagina in an Adolescent Female

A 16-year-old female presented with dribbling of urine along with voluntary voiding since birth. Renal imaging revealed hydroureteronephrosis on the right side; the uterus and ovary were normal. A radionuclide scan showed a left nonfunctional kidney. On cystovaginoscopy, the urethra was shown to be normal and the urinary bladder was tubular with small capacity and an absent trigone. Although the vagina was capacious, no ureteric orifices were found. Computed tomography corroborated the diagnosis of bilateral, single ectopic ureters draining into a grossly dilated vagina. This case is unique because it is a bilateral single-system ureteral ectopia in a completely differentiated female genital tract that presented late in adolescence. To the best of our knowledge, this is the second such ureteral abnormality reported in the literature so far. The patient underwent ileocystoplasty with right ureteric reimplantation and nephroureterectomy for the left nonfunctional kidney, which histopathology showed to be tuberculosis. The patient is continent with cystometric capacity of more than 300 mL.

Retroperitoneoscopic nephrectomy for treatment of a case of left single ectopic ureter accompanied by dysplastic kidney.

We report the case of a 7-year-old girl with a single ectopic ureter who was treated with retroperitoneoscopic nephrectomy for a chief complaint of urinary incontinence. Preoperative CT showed a contrasted dysplastic kidney of 1cm in the renal fossa and a left ureteral opening into the vagina. Retroperitoneoscopic left nephrectomy was conducted with opening of the lateroconal fascia to enable identification of the dysplastic kidney. No intraoperative complications were encountered. Urinary incontinence improved immediately after surgery. This case shows that a retroperitoneal approach can be used in nephrectomy if the position of the kidney can be determined preoperatively.

Laparoendoscopic Single-Site Ureteral Reimplantation as a Treatment of the Single Ectopic Ureter

Objective: Single ectopic ureters are a rare malformation in adults. We describe the technique, feasibility, and effectiveness of laparoendoscopic single-site (LESS) intracorporeal ureteroneocystostomy with the single ectopic ureter. Patients and Methods: A 53-year-old woman was referred with chronic urinary tract infection. Intravenous urography and voiding cystoureterography revealed a double collecting system and incomplete double ureter of the left kidney with an ectopic ureter and vesicoureteral reflux (VUR) grade 3. No bladder overactivity was found during the urodynamic study. The patient underwent LESS ureteral reimplantation. The procedure was done transumbilical by using a single incision laparoscopic surgery (SILS) port, roticulator instruments, and standard laparoscopic intracorporeal suturing with an Endo-stitch device. Patient demographic, preoperative symptom, radiological imaging, complications, and postoperative outcomes were analyzed. Results: LESS ureteral reimplantation was performed in the patient. The operative time was 180 min, with an estimated blood loss of <50 mL. No immediate postoperative complications were observed. Postoperatively, orals were allowed on day 1, and drain and Foley catheter were removed on days 3 and 7, respectively. The hospital stay was 4 days. Double-J stent was removed 6 weeks after surgery. The time to return to normal activity was 2 weeks. Urinary tract infection during follow-up was not developed. Follow-up intravenous urography confirmed reduction of hydronephrosis and good drainage. Conclusion: LESS ureteral reimplantation is an effective procedure with good results. It is an advanced laparoscopic technique that closely resembles open and laparoscopic surgical techniques and provides a safe alternative to existing methods. We believe that this procedure will become an established treatment option. No competing financial interests exist. Runtime of video: 6 mins 32 secs

Bilateral Single Ectopic Ureters: A Challenging Entity to Achieve Continence and Preserve Renal Function

Purpose Bilateral single ectopic ureters (BSEU) are associated to cervical dysplasia, hypoplastic bladder, urinary incontinence, and sometimes renal failure. The therapeutical challenge is to achieve continence with spontaneous voiding and preservation of renal function. The ideal management would be a conservative ureteral reimplantation and urethrocervicoplasty (UCP) to allow bladder growth, without requirement for enterocystoplasty and CIC. Our aim was to report our results in a cohort of 11 patients with BSEU. Material and Methods Retrospective study including prospective follow-up of patients from 1988 to 2009 in two tertiary centres. Modes of presentation, associated anomalies, surgeries, and their results on continence and renal function were reviewed. Results All 11 patients were females with a mean age of 11 years (range 2-21). Modes of presentation were prenatal diagnosis in 4, incontinence and/or UTI in 5, and an abnormal perineum at birth in 2. All had associated anomalies: either urinary (5 VUR, 6 ureteral bifidity, 10 hypoplastic bladder) and/or extra-urinary (5 caudal, 4 mullerian, 4 vertebral, 3 cardiac, 3 ophthalmic). Four had a degree of renal insufficiency, and 7 asymmetrical nuclear renal function. All had a median of 4 surgeries (range 1-6). Mean follow-up was 4.5 years (range 0.5-15). Only 3 had a reconstruction (i.e. ureteral reimplantation and UCP and/or cervical injections of bulking agents) without cystoplasty: 2 were continent, 1 was still too young. Seven needed reconstruction and enterocystoplasty with a catheterizable channel (mitrofanoff or monti): 5/7 were continent on CIC. One is awaiting reconstruction. One had renal transplantation. Conclusions Conservative management of bilateral single ectopic ureters is challenging but very seldom sufficient to achieve continence without a bladder augmentation.

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

Congenital H-type rectovaginal fistulas and single ectopic bilateral ureters are each rare malformations. We describe a baby girl with a congenital rectovaginal fistula diagnosed 2 years after correction of single ectopic bilateral ureters. To our knowledge, this is the first association of these entities. Repair of fistula was complicated by recurrence, requiring a second procedure. The recommended operation for this anomaly requires separating the suture lines on the vagina and rectum. The practice of simply oversewing and then buttressing the suture lines is probably not sufficient.

Single Ectopic Ureter: Diagnostic Value of Contrast Vaginography

To present the diagnostic results of contrast vaginography to detect a vaginal ectopic ureter, in addition to investigation with ultrasonography, intravenous urography, and technetium-99m-dimercaptosuccinic acid renal scan. A single ectopic ureter is a rare anomaly. Eighteen girls with a single ectopic ureter were treated at the Children's Hospital No. 1 from 1995 to August 2008. The diagnostic studies included ultrasonography, intravenous urography, renal scans, and, finally, vaginography with contrast if the renal scans could not detect the poorly functioning kidneys. Intravenous urography showed a poorly functioning kidney in 1 patient. Another 10 poorly functioning kidneys were revealed by technetium-99m-dimercaptosuccinic acid renal scan, but 7 kidneys were not identifiable using contrast, ultrasonography, or radionuclide. Of these 7 patients, 6 vaginal ectopic ureters were detected using contrast vaginography. All 18 dysplastic kidneys were surgically removed. The results of the study have demonstrated the satisfactory diagnostic value of vaginography as an imaging technique to detect the dysplastic kidney draining by a single ectopic ureter.

Use of collagen for endoscopic correction in complicated vesicoureteral reflux

Endoscopic treatment of children with primary vesicoureteral reflux (VUR) has become an alternative to long-term antibiotic prophylaxis and open surgery. The purpose of this study was to assess the efficiency and safety of endoscopic subureteral injections of collagen (STING) as a treatment for complicated VUR in children. Twenty-five patients (41 ureteral units) underwent a modified STING procedure for the correction of complicated VUR. Of these patients, five (nine refluxing units) had Hutch's diverticulum, 10 (17 refluxing units) had a duplex system, eight (10 refluxing units) had ureterocele, one (three refluxing units) had a unilateral triple ureter and one (two refluxing units) had a bilateral single ectopic ureter. Of these 41 ureteral units, 14 had grade III VUR, 17 grade IV and 10 grade V. Fourteen refluxing units (30%) received one session of STING, which was successful, and 27 (70%) needed a second session. A follow-up voiding cystourethrogram was performed 3 months after each session of STING. The mean follow-up period was 24 months (range 3-36 months). Of these 41 refluxing units, 34 were treated successfully and regression or downgrading occurred in seven. Follow-up i.v. pyelography or sonography did not reveal any urinary tract obstruction. The results of this study showed that endoscopic correction of these complicated refluxing ureters may be the first choice of treatment, but the technique must be modified to suit each individual case.

Bilateral single ectopic ureters with hypoplastic bladder: How should we treat these challenging entities?

Bilateral single ectopic ureters with hypoplastic bladder are rare and difficult to treat. Urinary diversion (e.g. by ileal conduit) is usually performed because of small bladder capacity. We report a case treated by staged operation without urinary diversion or bladder augmentation. The outcome shows that ureterovesicostomy between the dilated ureter and the bladder is a feasible method to increase capacity for bilateral single ectopic ureters with hypoplastic bladder.

Laparoscopic management of a single system ectopic ureterocele with transitional cell carcinoma in the distal ureter

Single system ectopic ureterocele associated with transitional cell carcinoma in the ureter has not been described previously. Only two cases of transitional cell carcinoma in a single ectopic ureter have been reported in the published literature. With the development of minimally invasive surgery, we report the first case of single system ectopic ureterocele with transitional cell carcinoma in the distal ureter that was successfully managed by laparoscopic surgery.

Staged treatment of hypoplastic bladder: A case with single ectopic ureter in a solitary kidney

We report on a successful treatment of hypoplastic bladder in a 5-month-old girl with single ectopic ureter in a solitary kidney. Side-to-side anastomosis was performed first between the urethral ectopic ureter and side wall of the bladder. Nine months later when the bladder capacity increased to 70 ml, ureterocystoneostomy was done through psoas hitch procedure. She retains urine of about 270 ml and evacuate completely at 14 years of age.

The diagnosis and treatment of renal dysplasis with single ectopic ureter

目的 探讨小儿先天性单肾发育不良合并输尿管异位开口的病因、诊断与治疗.方法总结分析自1984年以来15例经手术确诊为先天性单肾发育不良合并输尿管异位开口的临床资料.结果 15例患者均为女性,其中2例为亲姐妹,11例输尿管异位开口于阴道,4例开口于前庭.静脉尿路造影(IVU)患肾均不显影,对侧肾代偿性增大,常规B超均未能明确探及患肾.B超检查10例,6例发现患肾;彩色多普勒超声(CDI)检查8例,6例发现患肾;CT扫描7例,3例提示腹膜后有发育不良肾影.所有患者均经手术治疗而愈.结论先天性单肾发育不良合并输尿管异位开口可能具有遗传倾向,B超和CDI有助于提高术前诊断阳性率,手术切除发育不良肾脏及输尿管疗效确切。

Laparoscopic Excision of a Huge Pelvic Kidney Associated with a Didelphic Uterus and a Single Urethral Ectopic Ureter: a Case Report with a Review of the Literature

446 A pelvic kidney is frequently associated with Mullerian abnormalities such as a bicornuate or unicornuate uterus, clubfoot deformities, and cloacal exstrophy. In some cases it can appear as one component of a multi-malformation syndrome. However, a pelvic kidney with a didelphic uterus is an extremely rare finding. A didelphic uterus is usually associated with renal agenesis. Moreover, a pelvic kidney with a single ectopic ureter into the urethra is also rare. We present here a case of a huge ectopic dysplastic kidney that was associated with a didelphic uterus and a single urethral ectopic ureter.

Bilateral single system ectopic ureters in a male infant

Bilateral single-system ureteral ectopia is a rare congenital malformation. We report a case of a male infant with bilateral single-system ectopic ureters without diffuse hydronephrosis, vesicoureteral reflux, or a history of recurrent urinary tract infections. The patient presented for an evaluation of hydronephrosis associated with the upper pole of an apparently duplex left kidney detected by prenatal and postnatal ultrasonography. Cystoscopy revealed two ureteral orifices distal to the bladder neck with a dilated left upper-pole calix and no duplex kidney. No surgical intervention has been planned until his continence status has been clarified.

Single vaginal ectopic ureter of fetal metanephric duct origin, ipsilateral kidney agenesis, and ipsilateral rudimentary uterine horn of the bicornuate uterus

Congenital anomalies arising from the urogenital tracts are common. We experienced two cases of specific urogenital anomalies. Two Japanese women had a single ectopic ureter opening in the central wall of the vagina, ipsilateral kidney agenesis, and ipsilateral rudimentary uterine horn of the bicornuate uterus. One had squamous cell carcinoma of the uterine cervix, and the other had adenocarcinoma of the vagina arising from the ectopic ureter meatus, which was histologically confirmed as fetal metanephric duct remnant. One had vesico-vaginal fistula postoperatively, resulting from separating the ureter-like duct from the bladder. Concomitant occurrence of anomalies suggests the common genetic backgrounds, which are not well known. Clinically, the ectopic vaginal ureter is important as a possible background of vaginal adenocarcinoma, and information on the ureter-like duct course is required during surgery.

Single ectopic ureter inserting into a duplicated imperforate hemivagina: a rare cause of a fetal abdominal mass

We present a unique case of obstructed vaginal duplication with ectopic ureteral drainage of an ectopic dysplastic kidney presenting as an antenatal diagnosis of a pelvic mass.

Transitional cell carcinoma in a single ectopic ureter opening into the ejaculatory duct

The incidence of an ectopic ureter in male patients is low. The ectopic ureter in men often ends at the seminal tract in association with renal dysgenesis. Malignant transformation of this closed, nonfunctional urothelial system has been reported only once. To our knowledge, we report the first case of primary transitional cell carcinoma in a single ectopic ureter with a dysplastic kidney that terminated in the ejaculatory duct.