THE SINGLE ECTOPIC URETER

Objectives To correlate renal function with the site of the ectopic or ifice in patients with a single ectopic ureter and to evaluate the rol e of ureteric reimplantation in the preservation of renal function. Pa tients and methods Forty-four patients (41 female, age 1.5 months to 2 0 years) with a single ectopic ureter have been managed in our institu tion in the last 21 years. The classical symptom of continuous wetting with intermittent normal micturition was reported in most of the fema le patients. The investigative evaluation included intravenous urograp hy (IVU), cysto-urethroscopy, vaginoscopy with retrograde ureteric cat heterization, micturating cystourethrography (MCU) and ultrasonography , Diuretic renography was carried out in four patients after it became available in 1992, Renal function was assessed in relation to urinary tract anomalies and with outcome after ureteric re-implantation. Resu lts Thirty-eight patients (two males) had a unilateral ectopic ureter; the ectopic orifice was vaginal in 12, vestibular in 11, urethral in nine, at the bladder neck in two, the seminal vesicle in one and undet ermined in three. Twenty-one patients had renal and/or ureteric abnorm alities, with reflux detected on MCU in three ureters. Associated anom alies included hypospadias (two, one female), skeletal anomalies (two) , anorectal malformations (three), cryptorchidism (two), and unilatera l cystic ovary (one). Two patients had preoperative hypertension. In 1 5 patients, renal function was considered sufficient to justify ureter ic reimplantation, 14 of whom regained continence. One girl had suprap ubic leakage from the bladder and died during secondary nephroureterec tomy. Another girl had persistent incontinence; she was found to have contralateral duplex ureters with a vestibular ectopic orifice and was cured after upper polar heminephroureterectomy. IVU and renography ca rried out in two patients each within 4 weeks of surgery showed a mode rate improvement in renal function, Eight patients reported for follow -up after ureteric reimplantation (mean duration 11 months); none had hypertension or urinary infection. Twenty-three patients with rudiment ary kidneys underwent nephroureterectomy. Histopathological examinatio n of the excised kidneys showed moderate to severe dysplasia with chro nic pyelonephritis, Six patients (one male) had bilateral single ectop ic ureters, with normal renal function in the five females. Unilateral reimplantation in the boy resolved the symptoms; one girl died before surgery and the other four underwent bilateral ureteric reimplantatio n, after which one was dry for up to 3 h while the other three were in continent, one of whom subsequently underwent urinary diversion. Concl usions There was no clear correlation of renal function with the site of the ectopic ureteric orifice, as most of the patients with a vagina l ectopic ureter had sufficient renal function to justify renal preser vation. Ureteric reimplantation preserved renal function, although the improvement after surgery was determined by the degree of renal dyspl asia.