Ectopic ureter with complete ureteric duplication: Conservative surgical management

doi:10.1016/S0022-3468(96)90476-5

Journal of Pediatric Surgery

Volume 31, Issue 4, April 1996, Pages 467-472

https://doi.org/10.1016/S0022-3468(96)90476-5 Get rights and content

Abstract

To assess the outcome of conservative procedures, the authors reviewed their experience in the management of 31 ectopic ureters with complete ureteric duplication. Twentyeight girls and three boys (aged 19 days to 10 years; mean, 30 months) were operated on between 1968 and 1994. Twentyfour of the children presented for evaluation of dribbling urinary incontinence and/or febrile urinary tract infections; seven presented after prenatal ultrasonographic diagnosis of hydronephrosis. The location of the ectopic orifice was identified in 25 children: bladder neck (6), posterior urethra (6), vagina (7), and vestibule (6). Upper pole nephroureterectomy was performed in 16 children who had nonfunctioning renal segments. Ureterovesical reimplantation was performed in 10 children who had functioning segments. In five borderline cases, temporary cutaneous ureterostomy was performed, followed by ureteropyelostomy (2), ureterovesical reimplantation (2), and upper pole nephrectomy (1). Histological examination of the polar nephrectomy specimens showed lesions of dysplasia in only four cases (24%). The follow-up period ranged from 6 months to 20 years (mean, 66 months). All children who presented with incontinence became continent after polar nephrectomy or conservative surgery. One child required surgical revision of the ureteropyelostomy anastomosis. Of the 12 children who had ureterovesical reimplantation, none needed further procedures. Ectopic ureters in duplex systems with functioning renal segments should be conserved.

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Renal Pelvis and Ureter
2020, Urologic Surgical Pathology
The renal pelvis and ureter are muscular conduits lined by urothelium that propel urine from the renal calyceal system to the urinary bladder. The ureter and renal pelvis are affected by developmental, reactive, and neoplastic disorders. The developmental disorders are closely related entities that include abnormalities in ureteral number, ureteral location, and both structure and function of collecting system muscularis propria. The mucosa is the site of major reactive and neoplastic disorders.
Therapeutic mega-ureter primitive before one year of life, retrospective study of 20 years
2017, Progres en Urologie
Quelle prise en charge pour les méga-uretères primitifs chez les enfants de moins de un an ? La question est discutée dans la littérature et la controverse persiste.
Évaluer les risques et les résultats à long terme des prises en charges médicale et chirurgicale chez les enfants de moins de un an.
Étude rétrospective monocentrique de 1990 à 2010. Tous les enfants de moins de un an retrouvés ont eu une évaluation incluant un examen clinique, une échographie, une scintigraphie et une cystographie. Ils ont été répartis en deux groupes : groupe 1 : enfants opérés avant l’âge de un an, groupe 2 : enfants non opérés ou opérés après l’âge de un an. Nous avons analysé l’évolution à long terme de ces enfants sur les critères suivants : reflux, pyélonéphrites, évolution de la dilatation, fonction rénale, nécessité d’une reprise chirurgicale ou d’une chirurgie secondaire, et impact sur la fonction vésicale.
Soit 54 patients dans le groupe 1 et 56 dans le groupe 2. Pour un suivi médian de 12 ans. Un total de 101 garçons pour 9 filles (sex-ratio 11,22). Il y avait 57 MUP gauche (52 %), 22 droit (20 %) et 31 bilatéraux (28 %). Un total de 71 % de diagnostic anténatal. Pas de différence sur l’émergence de complications : 25 (groupe 1) versus 31 (groupe 2) OR = 0,69 ; IC 95 % (0,307 ; 1,574) ; p = 0,44. Pas de différence entre chirurgie secondaire et reprise chirurgicale : groupe 1 = 12, groupe 2 = 22, OR = 0,45 ; IC 95 % (0,17 ; 1,09) ; p = 0,06. Pas de différence pour l’incontinence diurne : OR = 1,04 ; IC 95 % (0,14 ; 7,64) ; p = 0,67. Soixante-seize enfants (69 %) avaient finalement été opérés, 12 enfants opérés deux fois (10,9 %) et 34 enfants (31 %) jamais opérés.
Le principal enjeu de la prise en charge des MUP est la préservation de la fonction rénale. Soixante-neuf pour cent de nos enfants ont bénéficié d’un traitement chirurgical à cause d’une altération de la fonction rénale inférieure à 30 %, d’une dilatation urétérale supérieure à 10 mm associée à un reflux ou de pyélonéphrites récidivantes. Un suivi clinique, échographique et isotopique régulier de dépistage est nécessaire et devrait être prolongé jusqu’à l’âge adulte.
5.
What is the proper way to manage complicated primary mega-ureter in infants under the age of one. This has already been discussed in the literature but the controversy remains.
Evaluate the long-term results of the management of mega-ureter based support under the age of one.
Single-center retrospective study from 1990 to 2010. All children under one year found were evaluated including clinical examination, ultrasound, scintigraphy and cystography. They were divided into two groups: group 1: children operated on before the age of one year, group 2 non-operated or operated children after the age of one year. We analyzed the long-term evolution of these children on the following criteria: reflux, pyelonephritis, changes in dilation, renal function, need for surgical revision or secondary surgery, and impact on bladder function.
In total, 54 patients were included in group 1 and 56 patients in group 2. In a median follow-up of 12 years. A total of 101 boys and 9 girls (sex-ratio 11.22). There were 57 left MUP (52%), 22 right (20%) and 31 bilateral (28%). A total of 71% of antenatal diagnosis. No difference on the emergence of complications: 25 (group 1) versus 31 (group 2) OR = 0.69; 95% (0.307; 1.574); P = 0.44. No difference between secondary surgery and revision surgery: group 1 = 12, group 2 = 22, OR = 0.45; 95% CI (0.17, 1.09); P = 0.06. No difference for daytime incontinence: OR = 1.04; 95% CI (0.14; 7.64); P = 0.67. Seventy-six children (69%) were finally made, 12 children operated twice (10.9%) and 34 children (31%) never made.
The main challenge of the MUP of management is the preservation of renal function. Sixty-nine percent of our children received surgery due to impaired renal function lower than 30% of urethral dilatation greater than 10 mm associated with reflux or recurrent pyelonephritis. Clinical monitoring, regular ultrasound and isotopic testing are necessary and should be extended to adulthood.
5.
Transvaginal Excision of Bilateral Single Ureteral Stumps of Refluxing Ectopic Ureters in an Adult Female with Urinary Incontinence
2015, Urology
To report a novel surgical technique of transvaginal excision of bilateral refluxing single ureteral stumps in an adult female, with emphasis on the technique, the difficulties of the procedure, and other surgical consideration such as bladder neck reconstruction and use of pubovaginal sling in patients with these congenital anomalies.
The procedure starts with cystoscopy for identification and catheterization of the orifices of remnant ectopic ureters. This is important to facilitate close dissection of ureteral stumps without the risk of vascular and visceral injury. A wide inverted U incision is made in the anterior vaginal wall to complete the dissection and excision for the remnants of ectopic ureters followed by water-tight closure for each ureterourethral junction. The procedure is completed with bladder neck reconstruction and pubovaginal sling with autologous rectus fascia.
The operative time was 3 hours, estimated blood loss was 50 mL, and hospital stay was 1 day. There were no intraoperative complications, and the patient went home on catheter drainage for 10 days with prophylactic antibiotics and anticholinergic medications. One-year follow-up showed her global satisfaction of 80%, and she uses one small pad per day as needed. She reported no more recurrent urinary tract infections, no difficulty of voiding, and no pain.
Transvaginal approach for excision of bilateral infravesical remnant of ectopic ureters in an adult female is feasible. Successful surgical outcomes require bladder neck reconstruction and use of autologous rectus fascia in patient with bilateral single-system ectopic ureters, as the sphincteric mechanism of the bladder neck is absent.
Report of a clinic case of a double system ectopic ureterocele in an African infant
2014, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
Studies have shown that lesions of dysplasia are present in 20%–30% of parts for polar nephrectomy in ectopic ureter [11–13]. Ectopic ureters into the bladder neck have a better prognosis and are preserved in 80% of cases, against 30% for ectopic urethral, 30% for vaginal ectopic and 60% for vulvar ectopic [14]. Surgical treatment seems to give the best long-term results for the treatment of ectopic ureterocele.
We report on the observation of a 30-month-old female newborn that was treated for a urinary infection. The medical imaging revealed the existence of a right double system ureterocele with vesicorenal reflux on the ureter of the upper pyelon and a bifid left ureter. The treatment consisted in an ureterocelectomy, a reimplantation of the two right ureters and a repair of the vesical floor. The external drainage of the upper pyelon allowed us to make sure of its functionality that was about 15% of the full renal function. The post-op follow-ups have been simple and thirteen months later, the newborn is doing well and does not present any sign of urinary infection.
Dismembered extravesical reimplantation of dilated upper pole ectopic ureters in duplex systems
2013, Journal of Pediatric Surgery
Citation Excerpt :
Nevertheless, upper pole ectopic ureters are rare and no large series or trials comparing different treatments exist to the best of our knowledge. Most of the series reported so far seldom include more than 3 cases of ectopic ureters per study year [1–5]. The criteria to define good upper pole function represent an additional issue.
We report the results in patients with obstructed upper pole ectopic ureters in duplex systems undergoing dismembered extravesical reimplantation of the upper pole ureter alone.
Between 01/2007 and 03/2012, 11 patients with an upper pole ectopic ureter (1 bilateral) diagnosed following the antenatal detection of hydronephrosis and showing preserved function on renal scintigraphy in a dilated upper moiety, underwent a dismembered reimplantation of the ectopic upper pole ureter as follows. The ureter was identified, separated from the lower pole ureter, and divided just above the bladder. The distal stump was suture closed, while the proximal segment was mobilized, tapered as necessary, and reimplanted using an extravesical technique.
Twelve ectopic ureters were reimplanted. Median (range) patient age at surgery was 8 (3–48) months. Ureteral tapering was performed in 11 ureters, by infolding in 9 and using an excisional tailoring in the single case undergoing bilateral reimplantation. After a median (range) follow-up of 17 (6–50) months, all patients were asymptomatic. Eleven reimplanted ureters showed improving hydroureteronephrosis, no obstruction on diuretic scintigraphy, and no evidence of reflux on indirect radionuclide cystography. One reimplanted ureter developed worsening hydroureteronephrosis after excisional tailoring of the ureter and partial nephrectomy was performed.
Extravesical reimplantation of the upper pole ureter is an option in dilated upper pole ectopic ureters with good function. Separating the upper and lower pole ureters proximally to the bladder does not jeopardize the ureteral blood supply and allows leaving the lower pole ureter undisturbed. Excisional ureteral tailoring should be avoided.
Ureteral ectopia inserting into ipsilateral epididymis resulting in inflammatory paratesticular tumor
2012, Urology
Citation Excerpt :
Our patient has done well in follow-up. Dysplasia rates as low as 24% have been described upon review of nephrectomy specimens for ectopic ureters (albeit none were known to drain as distant as the epididymis).14 In contrast, a study of obstructed renal units from pre- and postnatally diagnosed ectopic ureteroceles found dysplasia, scarring, or nephroblastematous changes in 100% of 15 patients.15
An 8-year-old male with a history of VACTERL association was found to have a paratesticular mass. The patient was treated successfully with a radical orchiectomy and found to have ureteral ectopia inserting into the ipsilateral epididymis, resulting in this paratesticular mass caused by inflammation of the epididymis. This is the only reported case in the English literature of an ectopic ureter inserting into the epididymis and presenting as a paratesticular tumor. In unclear cases of paratesticular, inflammatory appearing masses, inguinal exploration is warranted.

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: Presented at the 42nd Annual International Congress of the British Association of Paediatric Surgeons, Sheffield, England, July 25–28, 1995.

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Ectopic ureter with complete ureteric duplication: Conservative surgical management

Abstract

J Pediatr Surg

J Urol

J Urol

J Urol

J Urol