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[Ectopic ureter in 54 children]
1Department of Urology, Hyogo College of Medicine.
Insights
Pediatric ectopic ureters most commonly present as urinary incontinence or infection. Surgical treatments like ureterocystoneostomy offer high success rates, but some patients experience persistent incontinence due to anatomical abnormalities.
Area of Science:
- Pediatric Urology
- Congenital Anomalies
- Urinary Tract Disorders
Context:
- Ectopic ureters are a congenital anomaly where the ureter does not enter the bladder at the normal location.
- This condition can lead to significant urinary tract issues in pediatric patients.
- Understanding the presentation and treatment outcomes is crucial for effective management.
Purpose:
- To review the clinical presentation, anatomical locations, and treatment outcomes of pediatric ectopic ureters.
- To evaluate the effectiveness of surgical interventions for ectopic ureters in children.
- To identify factors contributing to persistent symptoms post-treatment.
Summary:
- This study retrospectively analyzed 54 pediatric patients with ectopic ureters treated between 1975 and 1999.
- Common presenting symptoms included urinary incontinence and high fever. Ectopic ureters were found to terminate in various locations, including the vagina, urethra, and seminal vesicles.
- Surgical management involved ureterocystoneostomy, nephroureterectomy, or other procedures, with most patients achieving symptom resolution. However, persistent incontinence was noted in some girls due to bladder neck or sphincter maldevelopment.
Impact:
- Highlights the diverse clinical manifestations of pediatric ectopic ureters.
- Provides insights into the efficacy of different surgical approaches.
- Identifies specific patient groups at risk for persistent urinary incontinence, guiding further management strategies.
Purpose:
We reviewed 54 pediatric patients with ectopic ureter treated at our institution from 1975 to 1999.
Materials And Methods:
Our series comprised 40 female and 14 male children, with age from 1 month to 11 years. Clinical records of the patients were reviewed retrospectively.
Results:
Chief complaint was urinary incontinence in 24, high fever in 18, abdominal mass in 6, scrotal swelling in 3 and growth retardation in 2 patients. Two patients were found to have ectopic ureters without symptom during urological work-ups for their anorectal anomaly. The ectopic ureters opened into vagina in 19, vestibulum in 8, bladder neck in 7, urethra in 17, seminal vesicle in 2 and ejaculatory duct in 1 patient (s). Treatment was ureterocystoneostomy in 30, nephroureterectomy in 19, hemi-nephroureterectomy in 2, and ureteral ligature in 1 patient (s). Postoperatively, most of the patients became symptom free except for 6 patients in whom urinary incontinence was not cured due to mal-development of the bladder neck and sphincter, and due to Gartner's duct cyst.
Conclusion:
Urinary incontinence and urinary tract infection are most frequent presentations of ectopic ureter in children. Although most of the patients are cured with ureterocystoneostomy or nephroureterectomy, some incontinent girls continue to have urinary incontinence due to mal-development of the bladder neck and sphincter or Gartner's duct cyst.