An ectopic ureter is a condition present at birth where one or both ureters, the tubes carrying urine from the kidneys, connect to an incorrect location outside the bladder. This congenital anomaly means the urinary drainage system does not form as expected during embryonic development.
Anatomy and Development of an Ectopic Ureter
The normal urinary tract functions with kidneys producing urine, which travels through two ureters to the bladder for storage. Urine is then expelled through the urethra. With an ectopic ureter, this normal pathway is altered.
Instead of connecting to the bladder, the ectopic ureter drains into an abnormal site. In females, these points commonly include the urethra, vagina, or uterus. For males, the ectopic ureter might drain into the urethra near the prostate, the vas deferens, or seminal vesicles. This deviation means urine can bypass the bladder’s control.
Recognizing the Signs and Symptoms
A primary indicator of an ectopic ureter, particularly in females, is continuous urinary incontinence. This is characterized by constant dribbling or dampness, even after successful toilet training. This differs from intermittent wetting, as it involves persistent leakage. The ectopic ureter’s termination point in females often lies below the bladder’s sphincter, preventing voluntary control over urine flow.
Recurrent urinary tract infections (UTIs) are another common symptom, often due to abnormal urine flow or poor drainage. Constant moisture from urine leakage can also lead to skin irritation. In males, symptoms may be less obvious, and incontinence is uncommon, as the ectopic ureter typically drains internally into structures like the urethra or seminal vesicles, remaining within the urinary sphincter’s control. Males may instead present with issues such as epididymitis, vesiculitis, or signs of kidney swelling from urine backup.
The Diagnostic Process
Diagnosing an ectopic ureter often begins with a thorough review of a patient’s health history and a physical examination. Initial imaging studies typically include a renal and bladder ultrasound, which uses sound waves to visualize the kidneys and bladder, helping to detect any dilation of the ureter or kidney swelling. This non-invasive test can provide early clues about the urinary system’s structure.
More specialized imaging is often required to pinpoint the abnormal ureteral opening. A voiding cystourethrogram (VCUG) involves filling the bladder with a solution via a catheter and taking X-rays as the bladder fills and empties, helping identify unusual drainage. A CT urogram, using contrast dye, provides detailed images of the urinary tract, visualizing the ureter’s path and termination point. A cystoscopy, an endoscopic procedure with a thin, lighted tube and camera inserted into the urethra and bladder, allows direct visualization of the bladder interior and can definitively locate the ectopic ureter’s opening.
Surgical Correction and Treatment
Surgical intervention is the definitive treatment for an ectopic ureter, aiming to achieve urinary continence and preserve kidney function. The most common procedure is ureteral reimplantation, also known as ureteroneocystostomy. During this procedure, the ectopic ureter is detached from its incorrect insertion point and reconnected to the bladder in a proper anatomical position. This allows urine to flow into the bladder normally, enabling the bladder’s sphincter to control urination.
The success rate for achieving urinary continence through ureteral reimplantation is high. If the kidney associated with the ectopic ureter has minimal to no function or is severely damaged, another surgical option is a nephroureterectomy. This procedure involves removing the non-functional kidney along with its entire ureter. The choice between these approaches depends on the affected kidney’s overall health and function.
Post-Surgical Recovery and Outlook
Following surgical correction for an ectopic ureter, a short hospital stay is required for monitoring and initial recovery. Patients may have a temporary urinary catheter to help drain the bladder and promote healing during the immediate post-operative period. The duration of catheterization varies based on the surgical approach and individual patient needs.
The long-term outlook after surgery is positive, with high success rates in achieving complete urinary continence. Regular follow-up appointments monitor recovery and ensure the repaired urinary tract functions effectively. These follow-ups may include imaging studies to confirm proper urine flow and kidney health.