Ureteral ectopic opening is when the ureter does not enter the bladder triangle and the opening is outside the bladder. The location of the opening is different in boys than in girls. In boys, the opening can be in the posterior urethra, vas deferens, seminal vesicles, and rectum with a sphincter at the end and no urinary gonorrhea. In girls, the incidence is four times higher than in boys, and the variation is greater. The opening can be in the urethra, vestibule, anterior vaginal wall, uterus, rectum, etc. The opening is small and difficult to find, as there is no sphincter at the distal end of the opening, and urinary dribbling occurs. There are many types of ectopic ureteral openings, with one focusing on the kidney with ectopic ureteral openings in the upper kidney, in about 80% of cases combined with repetitive malformations.
Diagnosis
(A) Clinical manifestations
1, urine dripping Women show continuous urine dripping between two normal urination, wet pants. More daytime and less nighttime. In men, because the ectopic opening is on the proximal side of the external sphincter, there is no dripping of urine.
2, perineal eczema due to urine irritation, serious local skin erosion, the body can smell the smell of urine.
3.Urinary tract infection Due to narrow ureteral orifice and poor drainage, resulting in recurrent urinary tract infection. Men also have symptoms such as recurrent epididymitis, vesiculitis and back pain.
(II) Examination
1, local examination female vulva and inner thighs flushing, urinary rash and erosion, carefully and patiently looking in the vulva, urine can be seen dripping from the small vestibular pore water droplet-like. The urine can be seen dripping from the vestibular orifice, or overflowing intermittently from the urethral door or vaginal opening. The male epididymis is enlarged and painful, and painful cysts can be palpated on anal examination.
2.Retrograde ureterogram If ectopic opening can be found, a catheter can be inserted from the opening to perform retrograde ureterogram to show the corresponding dilated ureter and dysplastic mallet-shaped kidney.
3.Intravenous urography can show the following conditions due to the poor development and low concentration of the duplicated kidney accompanying the ectopic opening with high dose and high concentration contrast and delayed film.
(1) The upper kidney is extremely faint.
(2) Reduced or absent number of calyces and oblique outward and downward displacement of the lower kidney.
(3) Dilated hydronephrosis on one side of a bilateral duplicated kidney with ectopic opening.
(4) A single ureter, with the affected kidney mostly unremarkable
(5) The bladder does not show up, indicating that both sides of the single ureter open ectopically.
4.Ultrasound examination The dysplastic duplicated kidney or ectopic small kidney, or dilated ureter behind the bladder can be detected.
5.Nephrogram nuclear scan Nephrogram can see the affected duplicated kidney and dysplastic ectopic kidney.
Treatment
Surgical treatment depends on the function of the affected kidney.
1.Nephrectomy For single ureteral ectopic opening with non-functional kidney, nephrectomy and ureterectomy are performed.
2.Heavy nephrectomy and ureterectomy If one kidney, the upper half of the kidney is hydronephrosis and non-functional, heavy nephrectomy and ureterectomy will be performed.
3.Vesicoureteral reimplantation If the affected kidney is quite functional and there is no infected hydronephrosis, or if the affected kidney is an isolated kidney, anti-reflux ureteral reimplantation is performed.
4.Ureteral anastomosis between upper ureter and lower renal pelvis or lower ureter After surgery, it is easy to cause fluid accumulation and infection, and should be used with caution.
5.Ureteral reimplantation and bladder neck reconstruction Bilateral single ectopic ureteral opening for ureteral bladder reimplantation, along with enlarged bladder and bladder neck reconstruction.
Follow-up】Ureteral reimplantation of the bladder should be followed by ultrasound examination 1-2 months after surgery to exclude postoperative obstruction and cystogram 3 months after surgery to understand whether there is vesicoureteral reflux.