Vaginal Ectopic Ureter Research Articles

Congenital ureterovaginal fistula: a rare case of single-system ectopic ureter with ipsilateral ectopic kidney managed by vaginal approach: a case report

BackgroundDiagnosing urinary incontinence from organic causes such as ectopic ureter is particularly important because of the potential for cure by surgical correction. The prevalence of ectopic ureter is uncertain because many are asymptomatic and the diagnosis is usually overlooked. Eighty percent of ectopic ureters in females are often associated with duplex kidney. However, an ectopic ureter draining a single-system ectopic dysplastic/atrophic but functioning kidney is rare, especially in females. The overall long-term continence rate after successful correction of ectopic ureter is satisfactory.Case presentationThis case is reported to highlight a rare situation, where a 22-year-old nulligravid Ethiopian women presented with a complaint of continuous wetting of her underwear since childhood, but she had normal voiding pattern. Localized right pelvic kidney ultrasound and computed tomography scan with contrast revealed right ectopic ureter and atrophied ipsilateral pelvic kidney with good function. Surgical reimplantation through vaginal approach was performed, and the outcome was good. The patient’s subsequent follow-ups were uneventful.ConclusionAn extramural vaginal ectopic ureter is better accessed through transvaginal approach than abdominal, especially when it is associated with pelvic ectopic kidney. This modified approach is less invasive and has lower morbidity and better success rate than a transabdominal approach.

Bilateral single system vaginal ectopic ureters: A rare variant

Bilateral single-system vaginal ectopic ureter (BSSVEU) is a very rare entity in pediatric urology. A 1-year-old girl was brought to outpatient clinic with continuous dribbling without normal voiding. The patient was diagnosed as BSSVEU by clinical findings, CT intravenous urography, genitoscopy and cystoscopy. Bilateral ureteric reimplantation was performed. Postoperative dry time was 2-3 hours after 3 months of follow-up and renal function was preserved at 3 months. Here, we report such a case and briefly discuss its diagnosis and management.

Prenatal diagnosis of fetal hydrocolpos with duplicated vaginal ectopic ureter: Case report

Introduction: Hydrocolpos is a vaginal distension caused by fluid accumulation due to an obstruction. Ureters duplication is a common anomaly diagnosed in childhood; ectopic ureters, however, are rare, and exceedingly rare is the prenatal diagnosis of these anomalies.

Errata for Docetaxel (Taxotere®)-induced cavitary change of pulmonary metastatic lesions complicated by bilateral spontaneous pneumothoraces in a patient with primary adenocarcinoma of the lung; and Y-type partial duplication of a vaginal ectopic ureter with ipsilateral hypoplastic pelvic kidney and bicornuate uterus

Errata for Docetaxel (Taxotere®)-induced cavitary change of pulmonary metastatic lesions complicated by bilateral spontaneous pneumothoraces in a patient with primary adenocarcinoma of the lung; and Y-type partial duplication of a vaginal ectopic ureter with ipsilateral hypoplastic pelvic kidney and bicornuate uterus

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

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.

Y-type partial duplication of a vaginal ectopic ureter with ipsilateral hypoplastic pelvic kidney and bicornuate uterus

We present a case of vaginal ectopic ureter with ipsilateral partial duplication of the upper ureter (Y-type ureter), ipsilateral hypoplastic pelvic kidney and bicornuate uterus in a 20-year-old woman who presented with mild urinary incontinence since infancy. Ultrasonography, computed tomography and intravenous pyelography examination showed a left kidney with no evidence of a right kidney. Cystourethroscopy showed absence of the right hemitrigone. Magnetic resonance (MR) urography demonstrated the presence of a bicornuate uterus, an ectopic dysplastic right kidney in the pelvic cavity, and a right ureter that terminates in the vaginae fornix. The patient underwent right nephroureterectomy and urinary continence was restored completely. Although congenital malformations of the urinary tract are frequently associated with genital tract abnormalities, to best our knowledge, this is the first report of the coexistence of all of these anomalies in an individual. Our report also highlights the importance of MR urography in the diagnosis of such rare and complex anomalies.

Novel bladder augmentation in a bilateral single system vaginal ectopia

A 3-month-old girl presented with total urinary incontinence along with small bladder and bilateral single-system vaginal ectopic ureters [BSSVEU]. Bladder augmentation was done with dilated ureters (ureterocystoplasty) based on proximal blood supply of the ureters.

A Modified Approach of Cystic Puncture With Contrast Medium Injection for Diagnosis of Obstructed Hemivagina and Urinary Tract Anomalies

This study investigated the diagnostic value of a modification of the conventional technique of X-ray imaging after cystic puncture with injection of contrast medium for obstructed hemivagina and related urinary tract anomalies in girls. The modified procedure made the following diagnostic findings: ipsilateral obstructed hemivagina in one patient with renal agenesis; vaginal ectopic ureter and ipsilateral obstructed hemivagina in one patient with renal dysplasia; and vaginal ectopic ureter, Gartner's duct cyst and ipsilateral obstructed hemivagina in six patients with renal dysplasia or aplasia. This modified method might have improved diagnostic value over the traditional method, and accurately identify genitourinary tract anomalies. It could therefore serve as an alternative and complementary method of sonography.

An Atrophic Crossed Fused Kidney With an Ectopic Vaginal Ureter Causing Urine Incontinence

An ectopic vaginal ureter is an infrequent cause of urinary incontinence. Most cases are associated with a duplex kidney in which the lower moiety ureter drains into the bladder. Occasionally, some cases of ectopic kidney with single vaginal ectopic ureter can occur. In this study, we present a case of chronic continuous urine incontinence caused by the extremely rare combination of a fused-crossed kidney and a single vaginal ectopic ureter. Laparoscopic nephroureterectomy was carried out smoothly and uneventfully. In our experience, laparoscopic navigation and surgery can be valuable tools to delineate and manage unusual congenital anomalies.

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.

Malformations of the Female Genital Tract and Embryological Bases

Female genital tract malformations are frequently a cause of reproductive problems. Besides, complex malformations also frequently generate serious gynecological problems, often ones with inappropriate surgical solutions, as the gynecologist does not think of the malformation as either the cause of the symptoms or of its embryonary origin. Apart from analyzing the embryological bases in the development of the female genital tract and insisting on the well known mullerian origin of the uterus, the ratification of the embryological hypothesis about the origin of the human vagina from the Wolff ducts and the Muller tubercle allows us to not only advance in knowledge but to use that knowledge for better clinical management of the problems generated by the complex malformations of the female genital tract. In this review we study the methods and means for the diagnosis of female genital-urinary malformations, their classification and clinical findings, and especially those cases involving unilateral renal agenesis, vaginal ectopic ureter and other complex malformations. We also analyze the related obstetric and gynecologic pathology, and especially that cases of complex genital malformations. We review the related literature and some interesting case reports, as well as our experimental studies in rats. After re-asserting our hypothesis about the embryology of the human vagina as derived from the Wolff ducts and the Muller tubercle, we suggest different recommendations for a better approach and management of the malformations of the female genital tract according to the findings observed in different diagnostic procedures. Keywords: Malformations of the female genital tract, complex malformations, embryology, embryology of the vagina, renal agenesis, blind vagina, mullerian anomalies, mesonephric anomalies

P48.03: Integration of imaging studies and endoscopic management of purulent vaginal discharge: undiagnosed vaginal ectopic ureter associated with ipsilateral dysplastic pelvic kidney and bicornuate uterus

P48.03: Integration of imaging studies and endoscopic management of purulent vaginal discharge: undiagnosed vaginal ectopic ureter associated with ipsilateral dysplastic pelvic kidney and bicornuate uterus

Transvaginal sonography in the morphological and functional assessment of segmental dilation of the distal ureter

Primary megaureter presents a spectrum of findings ranging from mild, clinically unimportant, stable ureterectasis to severe, progressive obstructive hydroureteronephrosis. We report a patient with a double uterus and ipsilateral renal dystrophy. A previous imaging study had revealed a double uterus and obstructed left hemivagina, into which a single vaginal ectopic ureter inserted. On follow-up intravenous urography 8 years later, the left kidney was non-functioning, and there was segmental dilation of the distal right ureter. Transvaginal sonography with real-time scanning and Doppler were useful in exploring the morphological and functional status of this dilated distal ureter.

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 Ureteral Ectopia with Congenital Renal Dysplasia

We reviewed the clinicopathological features and surgical management of 16 cases of single ureteral ectopia with congenital renal dysplasia. Excretory urography, retrograde ureterography, computerized tomography, diuretic B-mode ultrasound (B-US) and color Doppler imaging (CDI) were performed in 16 females. Explorative operations were performed in all 16 patients and renal dysplasia was further confirmed by pathological examination. The 16 female patients were 1.5 to 12 years old. The main clinical signs were urinary incontinence accompanied by regular voiding since birth. Vaginal ectopic ureters were observed in 6 patients and vestibular ureters in 10. Excretory urography did not show dysplastic kidney except some indirect signs of renal dysplasia. Computerized tomography clearly revealed renal dysplasia in 4 of 9 cases performed without contrast medium. Dysplastic kidneys were precisely located and diagnosed by diuretic B-US in 6 of 8 cases, and by CDI in 7 of 7 cases. Nephrectomy was performed in all 16 patients with satisfactory results. Single ureteral ectopia with congenital renal dysplasia is exceedingly rare. B-US, especially CDI, is the recommended procedure for preoperative localization and diagnosis. Nephrectomy of dysplastic kidney is the treatment of choice.

A Case of Unilateral Single Vaginal Ectopic Ureter with Ipsilateral Hypoplastic Pelvic Kidney and Bicornuate Uterus

A Case of Unilateral Single Vaginal Ectopic Ureter with Ipsilateral Hypoplastic Pelvic Kidney and Bicornuate Uterus

Single vaginal ectopic ureter and renal hypoplasia associated with urogenital sinus and abdominal muscular hypoplasia—a novel subtype of prune-belly syndrome in a female child?

We report a rare case that can be classified as prune-belly syndrome in a female. This patient came to our attention during the 19th week of gestation when massive ascites was found by ultrasound and the mother was transferred to our hospital. After birth, it was demonstrated that the infant had complicated anomalies, including abdominal muscular hypoplasia, urogenital sinus, a single, right-sided vaginal ectopic ureter, and hypoplasia of the right kidney. A sibling had a right hypoplastic kidney and right vesicoureteral reflux. Considering the combination of anomalies and the family history of urinary tract disease, her anomalies could be attributed to a genetic mutation.

Endoscopic Retroperitoneal Nephrectomy

Purpose: We describe modifications of the retroperitoneoscopic approach to the kidney, including the use of 2-mm instrumentation and prone positioning. Patients and Methods: Twenty-one children (13 girls, 8 boys; mean age 2.1 years) have undergone retroperitoneoscopic dissection in the prone position. An inflatable dissecting device was inserted into the retroperitoneum through a small incision at the lateral border of the sacrospinalis muscle, just below the costovertebral angle. After inflation, the dissecting device was replaced with a 5-mm cannula, the pneumoretroperitoneum was maintained with CO2 insufflation, and two 2-mm trocars were placed with endoscopic guidance. Dissection was performed using 2-mm instrumentation, and the specimen was extracted through the site of the largest port. Results: The children underwent nephrectomy, heminephrectomy, or total nephroureterectomy for chronic pyelonephritis with minimal function, reflux or obstruction with nonfunctioning kidney or moiety, multicystic dysplastic kidney, upper pole dysplastic moiety with associated ureterocele, or dysplastic kidney with a vaginal ectopic ureter. The mean operative time for the retroperitoneoscopic dissection was 142 minutes with an estimated blood loss of <15 mL. Conclusions: Several modifications to the retroperitoneal approach, including the use of prone positioning and 2-mm instrumentation, provide unobstructed viewing of the kidney and renal hilum and facilitate dissection in a small working space. These modifications may improve the safety and efficacy of this technique in children.

SPONTANEOUS RUPTURE OF THE UTEROVAGINAL SEPTUM IN 2 GIRLS WITH UNILATERAL HEMATOCOLPOS AND IPSILATERAL VAGINAL ECTOPIC URETER

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Jun 2000SPONTANEOUS RUPTURE OF THE UTEROVAGINAL SEPTUM IN 2 GIRLS WITH UNILATERAL HEMATOCOLPOS AND IPSILATERAL VAGINAL ECTOPIC URETER CHUNG-PIN SHEIH, YIU-WHA LI, TOH-SHUNG HUANG, YANG-JANN LIAO, and WEI-JAO CHEN CHUNG-PIN SHEIHCHUNG-PIN SHEIH More articles by this author , YIU-WHA LIYIU-WHA LI More articles by this author , TOH-SHUNG HUANGTOH-SHUNG HUANG More articles by this author , YANG-JANN LIAOYANG-JANN LIAO More articles by this author , and WEI-JAO CHENWEI-JAO CHEN More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67605-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "SPONTANEOUS RUPTURE OF THE UTEROVAGINAL SEPTUM IN 2 GIRLS WITH UNILATERAL HEMATOCOLPOS AND IPSILATERAL VAGINAL ECTOPIC URETER." The Journal of Urology, 163(6), pp. 1947–1948 References 1 : Early detection of unilateral occlusion of duplicated müllerian ducts: the use of serial pelvic sonography for girls with renal agenesis. J Urol1994; 151: 708. Abstract, Google Scholar 2 : Diagnosing the combination of renal dysgenesis, Gartner’s duct cyst and ipsilateral müllerian duct obstruction. J Urol1998; 159: 217. Link, Google Scholar 3 : Uterus didelphys with unilateral imperforate vagina: spontaneous rupture of the vaginal septum. Obstet Gynecol1980; 55: 505. Google Scholar 4 : Duplex kidney, Gartner’s duct cyst and ipsilateral müllerian duct obstruction. J Urol1998; 159: 2120. Link, Google Scholar From the Departments of Pediatrics (Sheih’s Clinic), and Obstetric Gynecology and Radiology, Taipei Municipal Women and Children’s Hospital, and Departments of Radiology and Surgery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 163Issue 6June 2000Page: 1947-1948 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsureterabnormalitieshematocolposrupture, spontaneousMetricsAuthor Information CHUNG-PIN SHEIH More articles by this author YIU-WHA LI More articles by this author TOH-SHUNG HUANG More articles by this author YANG-JANN LIAO More articles by this author WEI-JAO CHEN More articles by this author Expand All Advertisement PDF downloadLoading ...

PEDIATRIC RETROPERITONEOSCOPIC NEPHRECTOMY USING 2 MM. INSTRUMENTATION

We describe several modifications of the retroperitoneoscopic approach to nephrectomy for benign renal disease, including the use of 2 mm. instrumentation and prone patient positioning. A total of 14 children underwent retroperitoneoscopic nephrectomy in the prone position. An inflatable dissecting device was inserted into the retroperitoneum after a small muscle splitting incision was made at the lateral border of the sacrospinalis muscle approximately 1 cm. below the costovertebral angle. After inflation the dissecting device was replaced with a 5 mm. cannula and pneumoretroperitoneum was maintained with carbon dioxide insufflation. Two 2 mm. trocars were then placed under endoscopic guidance. Dissection was performed using 2 mm. instrumentation and the specimen was retrieved through the largest port site. Nephrectomy was performed in 9 girls and 5 boys 3 months to 9.8 years old. The preoperative diagnosis included chronic pyelonephritis with minimal renal function, reflux with a nonfunctioning kidney, multicystic dysplastic kidney, an upper pole dysplastic moiety with an associated ureterocele and a dysplastic kidney with a vaginal ectopic ureter. Mean operative time for retroperitoneoscopic nephrectomy was 142 minutes with an estimated blood loss of less than 15 ml. Contralateral ureteral reimplantation was performed after retroperitoneoscopic dissection in 5 patients. Overall average hospital stay was 2 days and there were no complications. Several modifications of the retroperitoneal approach, including the use of prone patient positioning and 2 mm. instrumentation for visualization and dissection, may improve the safety and efficacy of this technique in children.