A SINGLE-SYSTEM ECTOPIC URETER DRAINING AN ECTOPIC DYSPLASTIC KIDNEY - DELAYED DIAGNOSIS IN THE YOUNG FEMALE WITH CONTINUOUS URINARY-INCONTINENCE

Objective To document the array of diagnostic modalities, the variety of errant diagnoses and treatments, and the time from initial presenta tion to ultimate diagnosis in girls with an ectopic single-system uret er draining an ectopic hypoplastic and/or dysplastic kidney, Patients and methods Between 1990 and 1997, seven females were identified who h ad an ectopic hypoplastic and/or dysplastic kidney with an ectopically draining ureter, and who were treated at our institutions, either ini tially or upon referral. The nature and number of all diagnostic evalu ations, previous diagnoses and treatments, and the time from presentat ion to definitive diagnosis were recorded. Results All seven females h ad a classical history of successful toilet training, a normal voiding pattern and continuous urinary incontinence. Typically, a solitary ki dney was noted on the initial diagnostic evaluation by ultrasonography and/or intravenous urography. The mean (range) age at initial present ation was 3.2 (2-6) years. Additionally, voiding cysto-urethrography, urodynamics, radionuclide scintigraphy, computed tomography, magnetic resonance imaging and endoscopy were performed. The age at definitive diagnosis was 3-16.5 years and the mean (range) time from initial pres entation to diagnosis was 5.7 (1-10) years; Nephroureterectomy was cur ative and all kidneys were dysplastic. Conclusion Continuous urinary i ncontinence in females with a normal voiding pattern should prompt an evaluation for ureteric ectopia. When the initial evaluation yields th e diagnosis of a solitary kidney, clinicians should be aware of the po ssibility of a hypoplastic and/or dysplastic, often ectopic, contralat eral kidney with an ectopically draining meter, Identification of this entity should allow curative surgical treatment.