Diagnosis and treatment of unilateral ectopic ureter in children

Abstract

Objective To discuss the diagnosis and treatment of unilateral ectopic ureter in children. Methods The clinical data of 41 cases of ureteral ectopic children admitted to our hospital from January 2014 to June 2018 were retrospectively analyzed including the clinical features, diagnosis, surgical treatments. There were 4 males and 37 females patients, aged from 0.4 to 12.7 years, with an average of 3.5 years old. Urinary incontinence was the main manifestation in 35 cases, including 14 cases with urinary tract infection. Preoperative ultrasonography and IVP examination were performed in all the 41 children. The dynamic radionuclide renal imaging was performed in the children who showed no renal inhencement with IVP. There were 27 cases of ipsilateral renal duplication and 9 cases of ipsilateral renal dysplasia. Ectopic fusion of kidney with ipsilateral ectopic ureter has one case on each side, and bilateral renal duplication with ectopic fusion of kidney with left ureteral ectopic in 1 case. The ipsilateral kidneys were normal in 2 cases. There were 27 cases with renal duplication, 24 cases with upper renal dysplasia due to upper heminephrectomy, 3 cases with well upper renal function, 2 cases with lower superior ureteral pelvis anastomosis, and 1 case with ureterocystostomy.Laparoscopic dysplasia nephrectomy was performed on 9 patients with renal dysplasia, and nephrectomy was performed on 3 patients with renal dysplasia with ectopic renal fusion. Ureterocystostomy was performed in 2 cases with normal kidney. Results All 41 patients were followed up for 4-57 months, with an average of 25.3 months. Among the 35 children with urinary incontinence before the operation, 33 cases had complete disappearance of urinary incontinence symptoms, and 2 cases had urgent urinary incontinence after the operation, presenting as frequent and small amount of urine discharge, with a strong sense of urination urgency.The micturition interval was shortened, ranging from 30 to 40min in the daytime, and 2 to 3 hours at night. The parents of the children were required to remind them to micturate regularly. Of the 41 cases, 3 developed urinary tract infection 6-10 months after operation, and cured by antibiotics without recurrence. Conclusions Ectopic ureter is relatively rare, but urinary incontinence is the most common clinical manifestation. Ultrasound examination could be the preferred examination method. IVP further identified the patients with ectopic ureter who had kidney combined with malformation and renal function. The surgical treatments are mainly based on the corresponding renal function, and the prognosis is good. Key words: Urogenital abnormalities; Ureteral diseases; Ectopic; Diagnosis; Treatment