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Ectopic Ureter


Presentation

  • We present a case of a patient with a known solitary right kidney (congenital absence of a left kidney) presenting with lower urinary tract symptoms, absence of urinary incontinence, and feeling of bulge in the vagina.[ncbi.nlm.nih.gov]
Perineal Pain
  • A subfebrile (37.3 degrees C), 23-year-old patient, otherwise healthy, presented with persistent ascending perineal pain non-responsive to antibiotics and analgetics.[ncbi.nlm.nih.gov]
Right Flank Pain
  • However MR urography could establish the diagnosis. [ 5 ] Case presentation A 32-year-old patient who had four normal vaginal deliveries previously was referred to our clinic with complaints of intermittent right flank pain, normal urination, and continuous[ncbi.nlm.nih.gov]
Bladder Pain
  • .  PAIN: Uncommonly a/w acute infection, episodic obstruction of ectopic ureter or bladder pain caused by an obstructing ureterocele.  PROLAPSE: Ureterocele prolapse unusual; smooth, congested, mucosa covered interlabial masses protruding from urethra[slideshare.net]

Workup

  • Interestingly 19 of these patients initially had a negative diagnostic workup from a radiologic standpoint. These tests consisted of 15 intravenous pyelograms, 18 VCUGs, 14 ultrasounds, 5 cystoscopies, 1 nuclear VCUG and 1 MRI.[medicalnewstoday.com]

Treatment

  • After imaging studies including CT scan, MRI, or both were done, all the patients underwent laparoscopy for definitive localization and simultaneous treatment.[ncbi.nlm.nih.gov]
  • Once diagnosed, we are able to move to treatment under the same anesthesia episode. A high percentage of patients respond to treatment and response is often immediate.[vetmed.tennessee.edu]
  • What is the treatment for ectopic ureter? Our surgeons customize treatment for your child depending on the function of the upper portion of the affected kidney. If no function is present, we may remove that part of the kidney.[columbiadoctors.org]

Prognosis

  • MRI is also useful in the detection of other anomalies e.g. renal duplication, ureterocoele and vertebral anomalies Treatment and prognosis The more distal the insertion, the worse the prognosis.[radiopaedia.org]
  • However, ectopic ureter is essential for compatibility with life because it preserves the renal function. 7 Because of the associated abnormalities, the successful treatment and long term prognosis are very poor.[jpma.org.pk]
  • With appropriate management, the ultimate prognosis of duplicated ureter, ureteral ectopia, or ureterocele is excellent. Pathophysiology Ureteral embryology is fundamental in understanding abnormal development of the ureter.[emedicine.medscape.com]

Etiology

  • Etiology See etiology of ureteral duplication. Pathology of Ectopic Ureter 80% of ectopic ureters are associated with an ureteral duplication, especially in girls. In boys, the ectopic ureter may also drain a single renal system.[urology-textbook.com]
  • Etiology Ectopic ureters are a congenital condition that occur when the embryonic mesonephric and metanephric duct systems do not develop normally. The metanephric duct eventually develops into the ureter.[avmi.net]
  • Complex, CIBA, India Road, Goregaon (EAST), Mumbai -400 063 India Source of Support: None, Conflict of Interest: None DOI: 10.4103/0970-1591.57916 Abstract Single system ureteral ectopia and associated congenital dysplastic kidney is surgically curable etiology[indianjurol.com]
  • Epidemiology and Natural History 482 Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia 486 Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia 493 Retropubic and Suprapubic Open Prostatectomy 496 Epidemiology Etiology[books.google.ro]
  • […] demonstrate dilated collecting system, ectopic ureter, ureterocele, and extravesical insertion point of the ectopic ureter, and delineate malformation completely. [ 9 , 10 ] Diagnosis of suprasphincteric ureteral opening is made during investigations for the etiology[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology 1:2000, more girls than boys. Etiology See etiology of ureteral duplication. Pathology of Ectopic Ureter 80% of ectopic ureters are associated with an ureteral duplication, especially in girls.[urology-textbook.com]
  • […] and Natural History 482 Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia 486 Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia 493 Retropubic and Suprapubic Open Prostatectomy 496 Epidemiology Etiology[books.google.ro]
  • EPIDEMIOLOGY  Incidence of ureteral duplication- 1% (autopsy series).  Ureteroceles- 1 per 5000-12000 population; 10% bilateral, 60-80% ectopic, 80% a/w upper-pole ureter of a duplex system.[slideshare.net]
  • Epidemiological analysis of renal dysplasia. Modern Preventive Medicine 2003;11:200. 3. Mackie GG, Stephens FD. Duplex kidneys: A correlation of renal dysplasia with position of the ureteral orifice. J Urol 1975;114:274-80. 4.[jcrsmed.org]
  • Epidemiology United States statistics In autopsy series, the incidence of ureteral duplication is estimated at slightly less than 1%. In studies of young children with UTIs, the incidence of duplication rises to 8%.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Urinary incontinence is the most common clinical manifestation of ectopic ureters.[avmi.net]
  • Cutaneous Continent Urinary Diversion 459 Orthotopic Urinary Diversion 465 Genital and Lower Urinary Tract Trauma 468 Lower Urinary Tract Calculi 471 Development Molecular Biology and Physiology of the Prostate 476 Benign Prostatic Hyperplasia Etiology Pathophysiology[books.google.ro]
  • PATHOPHYSIOLOGY & EMBRYOLOGY Ureteral bud branch from mesonephric/Wolffian duct Extends into nephrogenic blastema(undifferentiated mesenchyma) Formation of the entire renal collecting system Distal to ureteric bud, mesonephric duct incorporates into UGS[slideshare.net]
  • CrossRef PubMed Google Scholar Koff, S.A. (1990) Pathophysiology of ureteropelvic junction obstructions. Urol. Clin. North. Am. 17, 263–272.[link.springer.com]
  • Pathophysiology Ureteral embryology is fundamental in understanding abnormal development of the ureter. Ureteral development begins as early as 4 weeks' gestation.[emedicine.medscape.com]

Prevention

  • Understanding the pathogenesis may help develop preventive and renal preservation strategies. The Sonic hedgehog gene and bone morphogenetic protein 4 play crucial roles in preventing anomalies of the ureters and the external genitalia.[ncbi.nlm.nih.gov]
  • To prevent infection, the patient may be put on a low dose of antibiotics before surgery. The 3 types of surgery to fix this problem are: Nephrectomy Ureteroureterostomy Ureteral reimplantation Each option has pros and cons.[urologyhealth.org]
  • In infants, the small bladder can limit surgical reconstruction with regard to creating a ureteral tunnel that is long enough to prevent recurrent reflux.[emedicine.medscape.com]

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