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Bilateral single ureteral ectopia: difficulty attaining continence using standard bladder neck repair
V R Jayanthi1, B M Churchill, A E Khoury
1Division of Urology, Hospital for Sick Children, Toronto, Canada.
Insights
For bilateral single ectopic ureters causing urinary incontinence, bladder neck closure with appendicovesicostomy and augmentation offers the best continence solution. Other outlet resistance procedures showed suboptimal success rates in this patient group.
Area of Science:
- Pediatric Urology
- Congenital Abnormalities
Background:
- Bilateral single ureteral ectopia is a rare congenital anomaly.
- It is a significant cause of severe urinary incontinence in infants.
Purpose of the Study:
- To evaluate surgical management outcomes for bilateral single ureteral ectopia.
- To identify effective strategies for achieving urinary continence in affected patients.
Main Methods:
- Retrospective review of 7 patients (6 girls, 1 boy) diagnosed with bilateral single ureteral ectopia.
- Analysis of surgical procedures including ureteral reimplantation, bladder outlet resistance procedures, bladder augmentation, and appendicovesicostomy with bladder neck closure.
Main Results:
- Initial ureteral reimplantation did not resolve incontinence in 3 patients.
- Attempts to increase bladder outlet resistance (Young-Dees-Leadbetter, Kropp, Stamey, Burch, pubovaginal sling) were unsuccessful in achieving continence.
- Appendicovesicostomy with bladder neck closure, with or without bladder augmentation, resulted in complete continence in all 5 patients who underwent this approach.
Conclusions:
- Total day and nighttime continence for bilateral single ectopic ureters is best achieved through bladder neck closure combined with appendicovesicostomy and bladder augmentation.
- Procedures solely aimed at increasing bladder outlet resistance are suboptimal for managing this condition, even with concurrent bladder augmentation.
Purpose:
We reviewed the surgical results of the management of bilateral single ureteral ectopia, a rare congenital cause of severe urinary incontinence.
Materials And Methods:
We reviewed the records of 6 girls and 1 male infant who presented to 1 institution with this diagnosis in a 10-year period.
Results:
All patients were incontinent and 3 had undergone ureteral reimplantation as an initial procedure with persistent postoperative wetting. Of the 5 patients who underwent a total of 8 attempts at increasing bladder outlet resistance, including 3 Young-Dees-Leadbetter, 2 Kropp, 1 Stamey, 1 Burch and 1 pubovaginal sling procedure, 2 also underwent simultaneous bladder augmentation to increase bladder capacity. However, none of these children had satisfactory continence after the continence procedure. Three of these patients who subsequently underwent appendicovesicostomy with bladder neck closure are continent. The 2 remaining patients underwent initial appendicovesicostomy with bladder neck closure and augmentation, and they are also continent.
Conclusions:
In our series total day and nighttime continence was only achieved by bladder neck closure, appendicovesicostomy and augmentation. Attempts at increasing bladder outlet resistance in patients with bilateral single ectopic ureters led to suboptimal rates of success even when adequate bladder capacity had been ensured by simultaneous augmentation.
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