Vesical continence in bilateral ectopic single ureters

Purpose: We explore the possibility of gaining suitable vesical capacity an d continence in bilateral single ureters without having to resort to urinar y diversion or bladder neck reconstruction. Materials and Methods: In the last 10 years we treated 6 girls with bilater al ectopic ureters, and 2 with a single kidney and urethral ectopic ureter. Both ureters were ectopic in the urethra in 3 cases, and 1 ureter was inse rted in the urethra and 1 in the bladder neck in the other 3. Preoperative examinations included ultrasonography, cystography, excretory urography and endoscopy in all cases, and magnetic resonance imaging in 2. Patient age a t intervention ranged from 1 month to 8 years. Results: Cross-trigonal reimplantation of the ectopic ureters through a cor rectly positioned neomeatus was performed in 7 cases. In 2 patients it was impossible to reach the ureteral insertion from inside the bladder (1 urete r in 1 and both ureters in 1), and so the distal tract of these ureters was resected extravesically as close as possible to the urethra. One patient w ith a single kidney also had an anorectal malformation and a rectovaginal f istula. She had pelvic renal ectopia and the ureter was inserted beneath th e urogenital diaphragm causing minimal bladder capacity. Therefore, a sigmo id neobladder with appendicostomy was constructed according to the Mitrofan off principle. A Young-Dees bladder neck plasty was done in 2 patients at t he same time as ureteral reimplantation and 3 years later in 1. Followup ur odynamics revealed more than acceptable continence. Bladder capacity was in sufficient in only 1 polyuric patient. Conclusions: A bladder with bilateral ureteral ectopia is not necessarily u seless, and the majority of patients can achieve normal bladder function an d capacity along with normal transurethral voiding and satisfactory contine nce.