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Bladder dysfunction in children with bilateral single ectopic ureters
Insights
Bilateral single ectopic ureters in children can cause urinary incontinence due to bladder neck issues. Artificial sphincter implantation can resolve this, but timing is crucial for optimal outcomes.
Area of Science:
- Pediatric Urology
- Congenital Malformations
- Voiding Dysfunction
Background:
- Bilateral single ectopic ureters are rare pediatric urinary tract malformations.
- Standard ureteral reimplantation may not resolve voiding dysfunction caused by associated bladder trigone and neck abnormalities.
Observation:
- Two girls with bilateral single ectopic ureters treated with ureteral reimplantation experienced persistent urinary incontinence.
- Videourodynamic studies revealed no bladder overactivity but demonstrated inadequate bladder neck closure.
Findings:
- Successful management of incontinence was achieved in one patient with an artificial urinary sphincter.
- The other patient, aged 7, is awaiting future surgical intervention due to age.
Implications:
- Consideration of bladder neck and trigone development is essential when planning surgical interventions for bilateral single ectopic ureters.
- Artificial urinary sphincter implantation is a viable option for treating refractory incontinence in these cases.
Background:
Single ectopic ureters are a rare malformation in children. Therapy consists of ureteral reimplantation. However, in case of bilateral single ectopic ureters, subsequent malformation of the bladder trigone and bladder neck may result in additional voiding dysfunction, and ureteral reimplantation alone may not solve the urologic problems.
Methods:
The authors report their experience with 2 girls, in whom bilateral single ectopic ureters were treated by ureteral reimplantation in early childhood and who did not gain adequate bladder control during following years.
Results:
Videourodynamic evaluation was done in both girls. No bladder overactivity was found during the urodynamic studies. However, cystography showed a widely open bladder neck during filling with no sufficient bladder neck closure shown by urethral pressure profile studies. When blocking the bladder outlet by balloon catheters, adequate bladder filling volume was achieved. Incontinence was cured by implantation of an AMS 800 artificial sphincter system in a 10-year-old girl. A 7-year-old girl was regarded to be too young for sphincter implantation and is waiting for surgery within the next years.
Conclusion:
Insufficient development of trigone and bladder neck with subsequent urinary incontinence has to be kept in mind when deciding on surgical procedures in children with bilateral single ectopic ureters.