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Pediatric Ectopic Ureter
What is an ectopic ureter?
A normal functioning urinary tract is made up of a right and left kidney that each connect to one bladder through a right and left ureter. When one of these ureters does not connect properly to the bladder and drains somewhere outside the bladder, this condition is called an ectopic ureter. In girls, the ectopic ureter usually drains into the urethra or even the vagina. In boys, it usually drains into the urethra near the prostate or into the genital duct system. Sometimes the ectopic ureter is connected to a partial kidney that is part of a duplicated kidney. This is not two separate kidneys, but one kidney that has two separate parts draining through two ureters on one side.
What are the symptoms of ectopic ureter?
- Urinary tract infection because of poor drainage
- Drainage of pus from the vagina in infant girls
- Testicular infection in boys (epididymitis)
- Inability to control urination (incontinence)
How is ectopic ureter diagnosed?
The method doctors use to diagnose a patient with an ectopic ureter usually depends on the symptoms a patient experiences.
- Prenatal ultrasound can be used to check for hydronephrosis, or the swelling of the kidney. Ultrasounds can also detect if a kidney is duplicated and if this is associated with incontinence, an ectopic ureter may be the cause.
- A kidney ultrasound can usually detect a dilated part of the kidney that may be connected to the ectopic ureter. This might occur in the evaluation after a urinary infection.
- A bladder X-ray, called a voiding cystourethrogram (VCUG) is often taken to rule out vesicoureteral reflux, when urine flows backward from the bladder, as the cause for swelling of the kidney and ureter.
- A renal scan (DMSA or MAG-3) can determine how well the kidney, or portion of the kidney, near the ectopic ureter works.
- A cystoscopy may be performed where a small telescope is placed into the urethra and vagina and the openings of the ureters from both kidneys are identified.
- A CT scan or MR study (magnetic resonance) is occasionally needed to see the ectopic ureter and the portion of the kidney it drains.
How is an ectopic ureter treated?
Children’s National offers three techniques to treat ectopic ureter. Each child is unique and the medical team will work with the family to determine the best option.
- Nephrectomy: If the entire kidney does not function because of the ectopic ureter, removal of the kidney is recommended. This is often done through minimally invasive or robotic surgery.
- Ureteropyelostomy or upper-to-lower ureteroureterostomy: If the upper portion of the ureter shows enough function, one option is to connect the upper portion that does not drain to the right place to the non-obstructed lower portion of the ureter or pelvis of the kidney. This can be done with open surgery, laparoscopic surgery, or robotic surgery.
- Ureteral reimplantation: In this operation, the ectopic ureter is divided near the bottom and sewn into the bladder in such a way that urine drains well and does not flow backwards. This can be done with open surgery, laparoscopic surgery, or robotic surgery.
What can be expected after treatment for ectopic ureter?
Recovery depends on the treatment. However, infants and small children are usually hospitalized from one to five days after open surgery, depending on age, and one or two days after laparoscopic or robotic surgery. A small catheter may be left at the time of surgery, which is removed painlessly and quickly before the child goes home or in the office at a follow-up visit.
At Children’s National Hospital in Washington, D.C., our pediatric urologists provide comprehensive care for disorders affecting reproductive and urinary organs.
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