Ectopic Ureter: Diagnosis and Medical Management

2019 ◽  
Author(s):  
Austin Hester ◽  
Anthony Atala
Keyword(s):  
Medical Management ◽  
Pediatric Population ◽  
Urogenital Sinus ◽  
Voiding Cystourethrography ◽  
Ectopic Ureter ◽  
Ureteral Orifice ◽  
Nuclear Scintigraphy ◽  
Key Words Ct ◽  
Uncommon Presentation ◽  
Multiple Imaging

The ectopic ureter is an uncommon presentation in the pediatric population with a 6 to 1 female-to-male prevalence. From an embryologic standpoint, ectopic ureters form as a result of failure of proper development of the urogenital sinus with ectopic development of the ureteral orifice. They are most often associated with a duplicated collecting system. The location of the orifice is most commonly in the posterior urethra. Diagnosis is usually made with a combination of multiple imaging modalities, including ultrasonography, voiding cystourethrography, nuclear scintigraphy, and sometimes CT or MRI. In this review, we detail the origin of the ectopic ureter and discuss diagnosis and medical management.  This review contains 3 figures, and 29 references. Key words: CT, cystourethrography, ectopic ureter, MRI, renal duplication anomalies, ultrasonography, voiding nuclear scintigraphy

Ectopic Ureter: Surgical Management

2019 ◽  
Author(s):  
Austin Hester ◽  
Anthony Atala
Keyword(s):  
Surgical Management ◽  
Conservative Management ◽  
Pediatric Population ◽  
Ectopic Ureter ◽  
Renal Unit ◽  
Ureteral Reimplantation ◽  
Live Births ◽  
Uncommon Presentation ◽  
Surgical Options ◽  
Cutaneous Ureterostomy

The ectopic ureter is an uncommon presentation in the pediatric population, seen in approximately one in 2,000 live births with a female prevalence. However, observation and conservative management have a short-lived role as many of these children are incontinent or symptomatic from an obstructed system. Urgent decompression of an infected system may be required as a temporizing measure before definitive surgical management can be pursued. In this review, we discuss the surgical options available for the ectopic ureter. This includes heminephrectomy of the nonfunctioning renal unit and reconstructive measures such as ureteral reimplantation, ureteroureterostomy, and ureteropyelostomy. We also discuss the management of the remnant ureteral stump and concomitant vesicoureteral reflux.   This review contains 1 figure and 35 references. Key words: cutaneous ureterostomy, ectopic ureter, renal duplication anomalies, heminephrectomy, ureteral reimplantation, ureteropyelostomy, ureteroureterostomy

An occult ectopic parathyroid adenoma in a pediatric patient: a case report and management algorithm

2017 ◽  
Vol 30 (9) ◽  
Author(s):  
Brent D. Bauman ◽  
Maria Evasovich ◽  
Amanda Louiselle ◽  
Eugene Zheng ◽  
Kevin Goodwin ◽  
...  
Keyword(s):  
Case Report ◽  
Parathyroid Adenoma ◽  
Pediatric Patient ◽  
Pediatric Population ◽  
Preoperative Imaging ◽  
Management Algorithm ◽  
Postoperative Mri ◽  
Complex Patients ◽  
Multiple Imaging ◽  
Parathyroid Adenomas

AbstractBackground:Hyperparathyroidism (HPT) is a rare disease in the pediatric population, and optimal management may be unclear if it is due to an occult parathyroid adenoma. We present a case report of a pediatric patient with an occult, ectopic, supernumerary, parathyroid adenoma.Case presentation:A 13-year-old female who initially presented with anxiety was diagnosed with HPT. Preoperative imaging and bilateral neck exploration with four-gland biopsy were negative for any parathyroid adenoma. Postoperative MRI identified a thymic mass. She subsequently underwent video-assisted thoracoscopic thymectomy with resection of an intrathymic parathyroid adenoma.Conclusions:The diagnosis of pediatric HPT is increasing. Supernumerary or occult parathyroid adenomas are rare and add complexity to presurgical planning and management. Our case represents the rare occurrence of a pediatric ectopic supernumerary occult parathyroid adenoma treated with a two-stage approach utilizing multiple imaging studies. We provide a review of the pathology and propose an algorithmic approach to manage these complex patients.

scholarly journals Positional installation of contrast cystography: A new approach in the diagnosis of vesicoureteral reflux

2008 ◽  
Vol 136 (11-12) ◽  
pp. 617-620
Author(s):  
Milan Paunovic ◽  
Polina Pavicevic ◽  
Vladimir Radlovic ◽  
Vojkan Vukadinovic
Keyword(s):  
Contrast Medium ◽  
Vesicoureteral Reflux ◽  
Diagnostic Procedures ◽  
Voiding Cystourethrography ◽  
Ureteral Orifice ◽  
Endoscopic Appearance ◽  
New Approach ◽  
Normal Finding ◽  
Normal Limits ◽  
Grade Ii

INTRODUCTION Positional installation of contrast cystography (PIC cystography) represents a new method to identify vesicoureteral reflux (VUR) that is unrevealed by standard diagnostic procedures. It is performed by radiological examination of the vesicoureteral junction during cystoscopic installation of the contrast medium at the ureteral orifice. OBJECTIVE We studied the significance of PIC cystography to demonstrate VUR that failed to be revealed by standard voiding cystourethrography (MCUG), as well as the degree of the correlation of such a finding with endoscopic appearance and the position of the ureteral orifice (UO). METHOD The aim of the paper was to analyze a sample of 5 children (4 girls and 1 boy), aged 6-15 years (mean 9.8 years) with recurrent febrile urotract infections, complicated with scarring changes of the renal parenchyma and normal findings on MCUG. The grade of VUR demonstrated by PIC cystography was classified using the standard hydrodistensional scale. RESULTS All 5 patients had VUR, disclosed by PIC cystography, of whom in 4 it was unilateral and in one bilateral. Of 5 patients, 4 had VUR grade I and one grade II. All the children with VUR detected by PIC cystography also had evident cystoscopic abnormalities in the position and/or configuration of the ureteral orifice at the same side, while at the side with normal finding on PIC cystography, the endoscopic finding was also within normal limits. CONCLUSION PIC cystography is the method of choice in the confirmation of VUR as the cause of recurrent urotract infection and its complications in children with a normal finding on standard MCUG. In all our patients with VUR verified by PIC cystography, at the same side we also revealed endoscopic changes in the position and/or configuration of UO.

A violation of the Weigert-Meyer law – an ectopic ureter arising from the lower renal pole

2015 ◽  
Vol 10 (3) ◽  
pp. 202-204 ◽  
Author(s):  
Kirtishri Mishra ◽  
Christopher S Elliott
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Ectopic Ureter ◽  
Ureteral Orifice ◽  
Ectopic Ureters ◽  
Tract Infections ◽  
Relationship Of ◽  
The Relationship ◽  
Duplicated Ureter

Ectopic ureters are a found in one of every 2000–4000 people. This abnormality can present with urinary tract infections, haematuria, and occasionally incontinence. Ectopic ureters traditionally follow the Weigert-Meyer Law, which describes the relationship of the lower and upper renal moieties. It states that the lower renal pole drains into a laterocranial ureteral orifice (and may reflux), while the upper renal pole drains into a mediocaudal ureteral orifice (and may be obstructed). If a duplicated ureter does not insert into the bladder, it by rule, originates from the upper pole. We present a case of a 42-year-old male who was incidentally found to have what appears to be an ectopic ureter draining from the lower renal pole into a structure contained in the scrotum, hence violating the Weigert-Meyer law.

Long-Term follow-up of Trigonoplasty Antireflux Operation

2016 ◽  
Vol 84 (1) ◽  
pp. 48-50 ◽  
Author(s):  
Farzaneh Sharifiaghdas ◽  
Nastaran Mahmoudnejad ◽  
Amir H. Kashi ◽  
Mehdi H. Ramezani ◽  
Behzad Narouie
Keyword(s):  
Urine Analysis ◽  
Voiding Cystourethrography ◽  
Ureteral Orifice ◽  
Abdominal Sonography ◽  
Antireflux Operation ◽  
Long Term Follow Up ◽  
Direct Radionuclide Cystography ◽  
History Of

Background Open trigonoplasty antireflux operation has been associated with promising results. However, its success in controlling reflux has not been evaluated in the long term. Methods All patients who underwent trigonoplasty for vesicoureteral reflux by one surgeon from 2004 to 2014 were included. Pre-Operative evaluations included direct radionuclide cystography (DRNC) or voiding cystourethrography, urine analysis and culture and abdominal sonography. Urodynamic study and cystoscopy was performed in selected patients. Trigonoplasty was done by a modified Gil-Verent method. The latest available patients’ DRNCs were used to judge for reflux relapse. Results Ninety-one patients, 142 refluxing units; median (range) age, 10.5 (1-45) years; M/F, (11/80) were followed for 18 to 135 months. Reflux resolution rate was 73.6% for patients and 75.4% for refluxing units. Relapse was associated with reflux grade (67% in grade V), ureteral orifice appearance (40% in golf hole/stadium), and patients with a history of pyelonephritis. Multivariable model based on the above variables had less than 10% sensitivity in predicting relapse. Conclusions Trigonoplasty success rate can decrease with long-term follow-up.

scholarly journals Renal dysplasia with the ipsilateral ectopic ureter mimicking abscess of the prostate

2014 ◽  
Vol 71 (2) ◽  
pp. 211-213
Author(s):  
Dragan Grbic ◽  
Dimitrije Jeremic ◽  
Sasa Vojinov ◽  
Milan Popov ◽  
Goran Marusic
Keyword(s):  
Clinical Symptoms ◽  
Renal Dysplasia ◽  
Left Lobe ◽  
Definitive Diagnosis ◽  
Urogenital Sinus ◽  
Perineal Pain ◽  
Ectopic Ureter ◽  
Prostatic Abscess ◽  
C 23 ◽  
Magnetic Resonance Imaging Mri

Introduction. In males the ectopic ureter usualy drains into the prostate (50%). During ureteric developement a thin membrane (Chawalla?s membrane) separates the lumen of the ureter and the urogenital sinus at the point where the ureter joins the urogenital sinus. This membrane ruptures allowing urin to drain from the ureter to the urogenital sinus. The authors reported a case of renal dysplasia associated with ipsilateral uretral ectopia mimicking prostatic abscess. Case report. A subfebrile (37.3?C), 23-year-old patient, otherwise healthy, presented with persistent ascending perineal pain non-responsive to antibiotics and analgetics. Digitorectal examination (DRE) showed asymmetric prostate with a soft, tender, buldging left lobe suggestive of prostatic abscess. The diagnosis was suspected using transrectal ultrasonography (TRUS), but the picture of the anechoic tubular structure in the left lobe of the prostate with a proximal undefined extraprostatic extension and a caudal intraprostatic blind end was incoclusive for the definitive diagnosis of prostatic abscess. Magnetic resonance imaging (MRI) was ordered and definitive diagnosis of renal dysplasia associated with the ipsilateral ectopic ureter filled with inflamed content mimicking prostatic abscess was made. Transurethral incision/minimal resection of the distal, blindly closed end of left ectopic ureter was done. Endoscopic surgical treatment was sufficient for relief of clinical symptoms. The patient?s recovery was uneventful. Conclusion. To the best of our knowledge, a case of renal dysplasia with the ipsilateral ectopic ureter mimicking prostate abscess has not been reported so far. Cystic pelvic malformations in males may result from too craniall sprouting of the ureteral bud, with delayed absorption and ectopic opening of the distal end of the ureter.

scholarly journals Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tetsuji Maruyama ◽  
Kentaro Mizuno ◽  
Hidenori Nishio ◽  
Taiki Kato ◽  
Takashi Hamakawa ◽  
...  
Keyword(s):  
Vesicoureteral Reflux ◽  
Injection Therapy ◽  
Voiding Cystourethrography ◽  
Implantation Technique ◽  
Ureteral Orifice ◽  
Endoscopic Injection ◽  
Implantation Techniques ◽  
History Of ◽  
Grade 3 ◽  
Grade Iii

Abstract Background To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in post-pubertal patients with dilated ureteral orifice via modified hydrodistension implantation techniques. Methods We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer/hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively. Results From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range 15–61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in 1 ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Median follow-up duration was 23 (range 13–63) months long. Although, 3 patients were experienced f-UTI 1–2 times, repeated VCUG showed no VUR recurrence. Conclusions According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in post-pubertal female patients with dilated ureteral orifice. While ureteral deformities or a history of anti-reflux surgery may increase the risks, these can be managed with appropriate methods that ensure sufficient mound appearance and height.

scholarly journals Uncommon Presentation of a Benign Nasopharyngeal Mass in an Adolescent: Comprehensive Review of Pediatric Nasopharyngeal Masses

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Victor M. Duarte ◽  
Yuan F. Liu ◽  
Nina L. Shapiro
Keyword(s):  
Single Case ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Adolescent Male ◽  
Comprehensive Review ◽  
Uncommon Presentation ◽  
Nasopharyngeal Mass ◽  
Tertiary Care Institution ◽  
High Index Of Suspicion ◽  
Nasopharyngeal Masses

Nasopharyngeal masses in the pediatric population are quite rare, and the majority of these are benign. In adolescent boys, there should be a high index of suspicion for juvenile nasopharyngeal angiofibromas. When malignant, the most common lesions encountered are rhabdomyosarcomas, carcinomas, and lymphomas. We report a single case from a tertiary care institution of an adolescent male with an unusual presentation of a benign nasopharyngeal mass and provide a comprehensive review of pediatric nasopharyngeal masses. Whenever possible, radiographic imaging should be obtained, in addition to biopsy, to assist in the diagnosis of pediatric nasopharyngeal masses.

Sign in / Sign up

Export Citation Format

Share Document