Bilateral single-system ectopic ureters: a case report.

Abstract

Introduction: While 20% of ectopic ureters are bilateral, bilateral single-system ectopic ureters constitute a rare occurrence. They present as continuous incontinence in females owing to the ectopic ureteral openings being located outside the bladder. Managing bilateral single-system ectopic ureters can be challenging owing to the reduced bladder capacity and incompetent bladder neck. Major reconstructive procedures, such as bladder augmentation and bladder neck reconstruction, may be necessary in addition to ureteral reimplantation to address these issues.

Case presentation: A 14-year-old Ethiopian female adolescent presented with lifelong urinary incontinence and recurrent urinary tract infections. Physical examination was unremarkable, with no signs of neurologic disorder. Abdominal ultrasound imaging showed bilateral moderate hydroureteronephrosis. The voiding cystourethrogram showed a bladder capacity of 150 ml and a grade 4 vesicoureteral reflux in the left ureter. Computed tomography urography revealed a low-capacity bladder with bilateral ectopic ureteral openings and bilateral moderate hydroureteronephrosis. Cystoscopic examination revealed a wide urethra, with both ureteric orifices located within the urethra and an indistinct trigone. Bilateral Politano-Leadbetter ureteric reimplantation was then performed, which resulted in satisfactory continence during follow-up.

Conclusion: Bilateral single-system ectopic ureters represent an infrequent clinical entity. In such cases, modern imaging techniques can guide surgical planning, and in selected patients, ureteral reimplantation may allow normal bladder function and satisfactory continence without major reconstructive surgery.