Diagnosis of ectopic ureter as a cause of urinary incontinence

Female pediatric patients with continuous drip incontinence present a diagnostic challenge. At times, these symptoms may be due to an ectopic ureter inserting below the external sphincter. The evaluation may consist an ultrasound and voiding cystourethrogram (VCUG), but these may not be diagnostic and further evaluation may be necessary. We reviewed our experience with imaging modalities used to make the diagnosis of ureteral ectopia.

We reviewed the records of 24 female patients with incontinence after toilet training or other symptoms caused by ureteral ectopia. We focused on the initial imaging methods, the modality providing the definitive diagnosis, and outcome.

Twenty-four patients were identified with an ectopic ureter. Two patients had bilateral ectopia for a total of 26 ectopic ureters. Of the 24 patients, 19 initially had negative diagnostic tests. These combined tests consisted of 15 intravenous pyelograms (IVPs), 18 VCUGs, 14 ultrasound, five cystoscopies, one nuclear VCUG and one MRI. Two patients underwent computed tomography (CT) as the primary test revealing an ectopic system. Of the 26 ectopic ureters, the diagnosis was made by CT scan in 13, IVP in five, cystoscopy in six, and ultrasound in one. One ectopic ureter was identified by exploration. In no cases did a CT scan fail to identify an ectopic system.

Patients with an ectopic ureter often will have no abnormality on initial imaging studies. Our experience has shown that a CT scan with delayed contrast is the most sensitive, economic and readily available test for diagnosing ecoptic ureters and renal systems.