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[Ectopic ureter in infancy and childhood]
Insights
Ureteral ectopy, a condition where the ureter bypasses the bladder, was surgically treated in 10 patients. Diagnosis involved various imaging and endoscopic methods, with surgical intervention recommended for affected kidneys.
Area of Science:
- Urology
- Pediatric Surgery
- Medical Imaging
Background:
- Ureteral ectopy presents significant diagnostic and management challenges in pediatric patients.
- Constant wetting and urinary tract infections are common clinical manifestations in affected girls.
Purpose of the Study:
- To review surgical treatments for ureteral ectopy over a 15-year period.
- To highlight diagnostic modalities and advocate for specific surgical approaches.
Main Methods:
- Surgical treatment of 10 patients (2 infants, 7 children, 1 young woman) with ureteral ectopy.
- Diagnostic tools included intravenous urography, voiding cystourethrography, ultrasonography, isotope scan, endoscopy, and bladder instillation with methylene blue.
- Review of clinical findings, drainage sites, and associated anomalies.
Main Results:
- The girl-to-boy ratio was 8:2.
- Common drainage sites included the vestibule, urethra, and vagina.
- Associated anomalies, such as esophageal atresia, were noted in one neonate.
- Bilateral single ureteral ectopy was observed in one patient.
Conclusions:
- Surgical intervention is crucial for managing ureteral ectopy.
- Upper pole nephrectomy and proximal ureterectomy are recommended for duplicated systems with upper pole destruction.
- Early diagnosis and appropriate management are essential for optimal outcomes.
Abstract:
Two infants, 7 children and 1 young woman have been surgically treated for ureteral ectopy in the Departments of Paediatrics and of Urology of the Medical University of Pécs over the last 15 years (1974-1989). The girl/boy ratio was 8/2. In girls, who were otherwise toilet-trained with a normal voiding pattern, constant wetting and urinary infection were the leading clinical findings. The site of ureteral drainage was the vestibule in 4 patients, the urethra in 3, the vagina in 1, the prostatic utricle in 1, and it could not be determined in 1 girl. Diagnosis was based on intravenous urography, voiding cystourethrography, ultrasonography, isotope scan, endoscopy and filling up of the bladder with a methylene blue solution. The diagnosis was more obscure when the ectopic ureter drained a poorly functioning kidney. Considering that in ectopy with duplicated system the upper pole renal segment is almost always destroyed, upper pole nephrectomy and proximal ureterectomy are advocated. In 1 neonate with esophageal atresia and tracheo-esophageal fistula ultrasonography detected the ureteral malformation. In 1 girl bilateral single ureteral ectopy was found.