Isolated bilateral simplex ureteric ectopia: Bladder capacity as an indicator of continence outcome

Area of Science:

• Pediatric Urology
• Surgical Innovation
• Continence Management

Background:

• Isolated bilateral simplex ectopic ureters (BSEUs) present a significant surgical challenge, as ureteric reimplantation alone may not ensure continence.
• Early identification of patients requiring additional procedures for urinary continence is essential to prevent multiple interventions.

Purpose of the Study:

• To explore potential preoperative indicators for achieving postoperative continence in girls with BSEUs.
• To identify factors that predict the need for additional bladder neck (BN) surgery alongside ureteric reimplantation.

Main Methods:

• Retrospective review of patients with BSEU between 1985 and 2012.
• Assessment of bladder capacity using ultrasound, urodynamics, and cystoscopy, with calculation of expected bladder capacity for age (EBCA).
• Evaluation of ureteric ectopia site and bladder neck (BN) competence.

Main Results:

• Four out of five patients without BN surgery at reimplantation achieved age-appropriate continence.
• Among patients undergoing BN tightening, continence outcomes were variable, with some requiring further interventions.
• Five patients experienced significant renal impairment, potentially exacerbating continence challenges.

Conclusions:

• Preoperative bladder capacity and observed BN competence are key indicators for predicting continence after ureteric reimplantation.
• An empty bladder on ultrasound or a wide-open BN with small/moderate capacity may suggest the need for BN surgery.
• Bladder filling to at least 30% of EBCA or BN apposition may indicate suitability for reimplantation alone, though further BN procedures may be needed if continence is elusive.