Diagnosis and surgical outcomes of ectopic ureters in adults: A case series and literature review

Abstract

Objectives To evaluate functional outcomes of surgery in patients with ectopic ureters diagnosed in adulthood; to review the world literature. Patients and methods Patients were referred over 10 years. Data including surgical history, presenting symptoms, diagnostic modalities, interventions and functional outcomes were collected; and the world literature reviewed. Results 9 women and 1 man had a mean age of 37 (range 20‐58). All women were referred with lifelong leakage. The man was referred with storage LUTS. Three women had heminephrectomy/nephrectomy with the distal ureter left in‐situ prior to referral. MRI was the predominant diagnostic tool but often took senior review to confirm the diagnosis. Excision of the ectopic ureter was performed with bladder neck reconstruction in 6 women, with concomitant rectus fascial sling in one patient. 4 of 6 (67%) women were cured of their stress incontinence with the bladder neck reconstruction alone, whilst two required further intervention. Three women had nephroureterectomy alone as primary treatment of which two were cured. The single male had heminephrectomy and excision of seminal vesicle. Conclusions Ectopic ureter is a rare diagnosis in adults but should be considered in patients who describe lifelong incontinence. Fine slice MRI is the imaging of choice. Excision of the ureter with bladder neck reconstruction alone was successful in two‐thirds of patients, whilst further stress urinary incontinence surgery was required in one‐third. Malignancy in ureteric remnants is described in 8% of the world literature. Patients should be counselled of this risk if the ureter is left in‐situ.

Multi Imaging Modality in Diagnosis of Unusual Giant Hydronephrosis of the Non Functioning Lower Moiety in A Partial Duplex Kidney with Distal Ureteric Stricture

“…High resolution MR Urography is valuable in the evaluation of ectopic ureters as well as nonfunctioning renal poles even without contrast because they are frequently filled with T2-hyperintense fluid representing excreted urine [37,41,42]. The dynamic renal scintigraphy is the modality of choice to diagnose Yo-Yo reflux [12,43] which was not available at our Health Centre.…”

Urinary Incontinence in Adulthood in a Course of Ectopic Ureter—Description of Two Clinical Cases with Review of Literature

“…Toia et al pointed out the role of ectopic ureter in differential diagnosis of the lifelong urinary incontinence. They recommended MRI as an examination of choice in the diagnostic process and showed that patients with ectopic ureters might require additional treatments in order to achieve continence [ 10 ].…”

“…Duplex systems may have a broad spectrum of manifestation including ectopic ureter and continuous urinary leakage [ 8 ]. Although these pathologies are well known and described in pediatric patients, limited cases have been reported in adults until now [ 9 , 10 ]. We describe two cases with ureteral duplication and ureteric enuresis which became symptomatic in adulthood.…”

Gynecological Diagnosis and Treatment of Ectopic Ureter Insertion into Vagina: Analysis of Five Cases and a Literature Review

“…A previous study over 7 years reported that patients diagnosed with an ectopic ureter ranged in age from 1 to 13 years, with a mean age of 4.5 years [ 3 ]. Notably, the uncommon cases diagnosed in adults suggest that the prevalence of ectopic ureter may be higher [ 4 ]. Patients with ectopic ureter generally present with other malformations of the urinary system, such as a duplex or single collecting system, even with female genital tract anomalies [ 5 ].…”