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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.
- Abdominal ultrasound. A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to view internal organs as they function and to assess blood flow through various vessels.
- Voiding cystourethrogram (VCUG). A specific X-ray that examines the urinary tract. A catheter (hollow tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body) and the bladder is filled with a liquid dye. X-ray images will be taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.
- Mag-3 diuretic renal scan. A diagnostic nuclear imaging technique that is conducted by injecting a radioactive fluid into the vein. The radioactive material is then carried to the kidneys where it gives off signals that can be picked up by cameras. Midway during the procedure a diuretic medication is given to speed up urine flow through the kidneys. This helps detect any area of blockage in the urinary tract.
- 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.
Division Chief, Urology
Co-director, Spina Bifida Program
Director, Urology Fellowship
Medical Director, Informatics for Surgery
Co-Director, Spina Bifida Program
Director, Transitional Urology
Medical Unit Director, Prince George's County
Director, Kidney Stone Surgical Program
Emeritus Chair and Faculty, Urology
Associate Director, Ambulatory Telemedicine
Co-Director, Spina Bifida Program
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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