What are Ectopic Ureters?
In normal development, ureters (tubes that carry urine from the kidneys to the bladder) connect to the bladder at a specific location. In ectopic ureters, one or both ureters connect to the bladder in an abnormal position, often outside the bladder wall. They are more common in female with a ratio of 1-2 males per 6 females afflicted with the condition.
Types of Ectopic Ureters:
Ectopic ureters can be single or duplex. In females, more than 80% of cases are duplex, while in males, more than 75% are single.
Ectopic ureters can open in the urethra, urethral septum, vaginal vestibule, posterior urethra, seminal vesicle, prostate tube, or ejaculation duct.
Associated anomalies: Ectopic ureters are often associated with other anomalies, such as renal hypoplasia or dysplasia. In about 60% of cases, urinary tract abnormalities are associated with anorectal malformations.
Clinical Presentation:
Can vary widely depending on the severity and location of the ectopic ureter.
May include urinary tract infections (UTIs), urinary incontinence, or even no symptoms at all.
In severe cases, kidney damage can occur.
Diagnosis:
Voiding cystourethrogram (VCUG): A specialized X-ray that can visualize the flow of urine from the bladder to the kidneys.
Renal ultrasound: To assess kidney size and function.
Cystoscopy: A procedure to directly visualize the inside of the bladder.
Renal Flow Scan (MAG-3 or DMSA) or Magnetic Resonance Urogram
The kidney or part of the kidney drained by the ectopic ureter often doesn’t work well. In these tests, contrast dye liquid is injected. A special camera is used to spot radioactivity in the dye. MRI (magnetic resonance imaging) can also be used.
Management:
Observation: In some cases, observation may be sufficient, especially if the child remains asymptomatic.
Medications: Antibiotics may be prescribed to treat UTIs as also for prophylaxis.
Surgery: Surgical options may include:
Endoscopic procedures: To correct the ureteral-bladder junction.
Open surgery: In more complex cases. These may include Nephrectomy, Uretero-ureterostomy or Ureteric reimplantation if there is associated Vesicoureteral reflux.
Importance of Early Diagnosis:
Early diagnosis and treatment are crucial to prevent kidney damage and long-term complications.
Key Takeaways:
Ectopic ureters are an uncommon but important condition in pediatric urology.
Early diagnosis and appropriate management are essential to prevent kidney damage and ensure optimal long-term outcomes.
Continued research and advancements in minimally invasive surgical techniques are improving the management of ectopic ureters.
Disclaimer: This information is for general knowledge and educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment.
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