Masked ureteral duplication with ectopic ureter detected by magnetic resonance imaging

Normal functioning single system ectopic ureter draining into a Gartner's cyst: laparoscopic management

Association of single system ectopic ureter with normal functioning bilateral kidney and absence of congenital anomalies is very rarely reported in the literature. We are reporting for the first time a case of this type of anomaly in which uretral ectopia was draining into a Gartner's cyst and was managed by laparoscopy. A 16 year girl presented with normal voiding with continuous dribbling since birth. Voiding cystourethrogram, intravenous urogram, cystovaginoscopy and retrograde contrast study confirmed the diagnosis. Ultrasound of the whole abdomen and physical examination ruled out any associated congenital anomalies. Transperitoneal laparoscopic ureteric reimplantation was performed and distal stump was ligated. On follow-up at 3 months she was completely dry; her vaginoscopy showed disappearance of cystic bulge and her voiding cystourethrogram showed normal study without any reflux. When single system ectopic ureter opens into small-to-moderate size wide opened mouth vaginal Gartner's cyst, laparoscopic ureteric reimplantation and ligation of distal stump is an appropriate procedure.

[Magnetic resonance urography in the diagnosis of the ectopic ureters]

INTRODUCTION

Ectopic ureters are often very difficult to diagnose with conventional diagnostic modalities (physical examination, ultrasound, intravenous urography, cystography, urethro-cystoscopy, isotop examinations) in children.

AIM OF THE STUDY

The authors report their experience with a relatively new method, the magnetic resonance urography (MRU) diagnosing ectopic ureters in childhood.

METHOD

MRU was used in 7 girls to detect an ectopic ureter in the last 3 years. On the basis of typical clinical signs, an ectopic ureter was suspected in all patients, but it could not be demonstrated by conventional diagnostic methods. Thus, MRU was done to confirm the suspected diagnosis.

RESULTS

In all of the 7 patients, the examinations demonstrated ectopic ureters with the intraoperative findings further confirming the pre-operative diagnosis. In 2 patients, the intraoperative findings of the upper urinary tract anomalies were slightly different from the MRU report.

CONCLUSION

The MRU is a reliable diagnostic method to diagnose ectopic ureters which are not easily detectable with conventional diagnostic modalities.

Identification of ectopic ureter in incontinent girl using magnetic resonance imaging

We present the case of a 3.5-year-old girl who presented with continuous urinary leakage and a classic history suggesting an ectopic ureter, but an inconclusive physical examination and normal imaging by ultrasonography. Magnetic resonance imaging was finally able to identify an ectopic ureter draining a poorly functioning upper pole of a duplex system as the culprit. We discuss the increasing value of magnetic resonance imaging in identifying subtle pediatric genitourinary anomalies, such as in our case, and discuss the management options.

Laparoscopy for the diagnosis and treatment of radiologically occult but symptomatic hypoplastic kidneys

OBJECTIVES

To evaluate the efficacy of different imaging modalities for visualization of small poorly functioning hypoplastic and dysplastic kidneys and to assess the role of laparoscopy in localization and treatment.

METHODS

Between 1998 and 2002, 10 female patients who presented with urinary incontinence, flank pain, or hypertension secondary to small, poorly functioning hypoplastic or dysplastic kidneys were treated at our institute. We reviewed the results of the imaging studies, cystoscopy, and evaluation under anesthesia for these patients. After the diagnosis, all patients were treated with laparoscopic retroperitoneal or transperitoneal nephroureterectomy or nephrectomy.

RESULTS

Intravenous urography and ultrasonography failed to visualize the affected renal units in all 10 cases. Computed tomography could locate small dysplastic renal units in only 5 patients (50%). Dimercaptosuccinic acid renal scintigraphy was diagnostic in all 10 cases (100%). Magnetic resonance urography was done in 2 cases only, and the affected renal units were identified in both. Cystoscopy and vaginoscopy were inconclusive in all but 2 cases. Laparoscopy efficiently located the offending renal units in all 10 cases. In 9 cases, the affected renal units were located in the lumbar region, and in 1 case it was situated ectopically in the pelvis. All 10 patients underwent laparoscopic retroperitoneal or transperitoneal nephroureterectomy or nephrectomy and were asymptomatic after surgery.

CONCLUSIONS

Dimercaptosuccinic acid scintigraphy is an accurate and specific imaging modality for visualization of small hypoplastic renal units that are not visualized by conventional radiologic imaging techniques. Laparoscopy can be recommended as the ideal method of management, because it provides a minimally invasive technique for detecting the kidney and simultaneously correcting the problem.

The management of urinary incontinence in the exstrophy complex, posterior urethral valves, and infrasphincteric ureters

Urinary incontinence is a debilitating problem that requires careful evaluation. Causes of incontinence in children are numerous, and once the mechanism of incontinence has been identified, management can be planned carefully. The management and outcome in children born with the exstrophy-epispadias complex, posterior urethral valves, and children who have an infrasphincteric ureteric orifice are discussed in this article.