DETECTION OF A POORLY FUNCTIONING MALPOSITIONED KIDNEY WITH SINGLE ECTOPIC URETER IN GIRLS WITH URINARY DRIBBLING - IMAGING EVALUATION IN 5PATIENTS

OBJECTIVE, Some girls with lifelong continuous dribbling of urine desp ite successful toilet training have urographic or sonographic evidence of only one kidney. Such girls are likely to have a contralateral, po orly functioning, nonvisualized, malpositioned kidney with a nonduplic ated collecting system and ureter draining through an ectopic orifice, Our objective was to analyze our experience with this group of patien ts to determine how best to confirm the presence and show the location of this abnormal kidney, MATERIALS AND METHODS, We reviewed the medic al records and imaging studies of five such girls who were first seen at our hospital between 1975 and 1993 to determine how their poorly fu nctioning, malpositioned kidney was detected. The imaging studies incl uded sonography, excretory urography, vaginography, retrograde and int raoperative antegrade ureterography, renal cortical scintigraphy using Tc-99m-dimercaptosuccinic acid, CT, and MR imaging, RESULTS, All the abnormal kidneys were located on the left side. Excretory urography an d sonography showed the abnormal kidney in only one of these five pati ents. In a second girl, retrograde ureterography showed the ureter of the dysplastic kidney after an ectopic ureteral orifice was discovered in the vagina during examination under general anesthesia, In a third , reflux from the vagina during a vaginogram showed the abnormal kidne y. Renal cortical scintigraphy using dimercaptosuccinic acid showed th e dysplastic, malpositioned, poorly functioning kidney in three girls, CT with special attention to the region of radionuclide uptake seen o n scintigram showed the location of the dysplastic kidney more precise ly in two patients. CONCLUSION, A girl with continuous dribbling of ur ine despite normal voiding habits whose excretory urogram and sonogram reveal only one kidney should have a dimercaptosuccinic-acid scintigr am as the next imaging evaluation, A CT scan through the area of inter est as determined by the dimercaptosuccinic-acid scintigram will more accurately localize the often ectopic kidney, thus facilitating its re moval.