Diagnostic work-up and laparoscopic correction of an ectopic ureter
B N Cezarino1, R I Lopes1, L M Oliveira1
1Pediatric Urology Unit, Division of Urology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil.
Insights
Continuous dribbling in children may indicate an ectopic ureter associated with ureteral duplication. Surgical correction via ureteroureteral anastomosis effectively resolves symptoms, highlighting the importance of accurate diagnosis.
Area of Science:
- Pediatric Urology
- Congenital Anomalies
- Surgical Techniques
Background:
- Duplex renal collecting systems are common pediatric congenital anomalies.
- Continuous dribbling post-toilet training suggests ectopic ureter, often linked to ureteral duplication.
Observation:
- A 10-year-old girl presented with continuous dribbling, diagnosed via imaging and cystoscopy.
- A left-sided duplex system with an upper pole ureter ectopically inserting into the vagina was identified.
Findings:
- Diagnostic work-up included ultrasonography, CT, urethrocystoscopy, retrograde pyelography, and vaginography.
- Laparoscopy confirmed the duplex system, and a termino-lateral ureteroureteral anastomosis was performed.
Implications:
- Accurate localization of ectopic ureters is crucial for successful surgical correction.
- Ureteroureteral anastomosis provided immediate resolution of urinary dribbling in this case.
- This case highlights a comprehensive diagnostic and surgical approach for pediatric ectopic ureters.
Introduction:
A duplex renal collecting system is a common congenital anomaly in children. Continuous dribbling (especially if after the toilet-training period) should raise suspicion of the presence of an ectopic ureter, which is most often associated with ureteral duplication. This video will demonstrate the complete diagnostic work-up necessary in these cases.
Case Report:
A 10-year-old girl presented with continuous dribbling. Ultrasonography and computerized tomography depicted a duplex system on the left side, with the upper pole ureter ectopically inserting into the vaginal cavity and good upper pole renal parenchyma. A careful urethrocystoscopy showed a topic right ureteral orifice and a topic lower pole left ureteral orifice. Retrograde pyelography was performed and displayed normal left lower pole anatomy. A vaginography was performed, which showed reflux to the ectopic ureter. Vaginoscopy clearly identified the ectopic ureteral orifice. A guide wire was introduced through this meatus and retrograde contrast injection confirmed the diagnosis of an ectopic ureter.
Results:
At laparoscopy, a larger upper pole ureter and a normal lower pole ureter on the left side were identified. A termino-lateral ureteroureteral anastomosis was performed. After the procedure, the child reported immediate resolution of urinary dribbling.
Conclusion:
In order to optimize its surgical correction, efforts should be made to appropriate localization of the ectopic ureter.
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