What is Ectopic Ureter?

Most folks are born with 2 ureters, the tube that drains the urine from each kidney into the bladder.

But some babies are born with 2 ureters that drain one kidney. In these cases, one ureter drains the upper a part of "> a part of the kidney and therefore the second ureter drains the lower part of the kidney. As long as they both enter the bladder, this extra ureter is typically not a drag.

But if a toddler is born with a ureter that doesn't connect with the bladder, it can drain somewhere outside the bladder. This is called an ectopic ureter. In girls, the ectopic ureter can drain into the urethra (the tube leading out of the bladder that we use to pee out of) or maybe the vagina. In boys, it often drains into the urethra near the prostate or into the sex organs.

Causes

There are not any known causes for this congenital anomaly. This extra ureter just develops from one kidney. It can happen in boys or girls, but is more common in girls. There is also no proof that something during pregnancy causes it.

It is known to be hereditary (passed down in a family). If you had an ectopic ureter, then each of your children features a one-half chance of getting this duplicated system.

Symptoms

The general signs of ectopic ureter are:

Ø  Incontinence (bladder control problems with leaking)

Ø  Swelling in the abdomen

Ø  Urinary tract infections (UTI)

Ø  Vesicoureteral Reflux (VUR)

Incontinence

A blocked ureter or incontinence (leaking urine) are often signs of an ectopic ureter.

Ø     Boys with ectopic ureters do not often have incontinence, since the ureter drains inside the body. But they may still have signs of swelling or a UTI.

Ø    Girls with ectopic ureters may leak urine since the ureter drains into or near the vagina. This problem is clear after toilet training. It is unlike other types of incontinence. Instead, there's a general, all-over moistness instead of events where the bladder looses control. Some girls are going to be treated with drugs and other things for several years before the proper diagnosis is formed.

Swelling

The ureter and a part of the kidney can swell when it cannot drain properly. This is called hydronephrosis and it is easy to see on ultrasound.

In many babies, an ectopic ureter is found when the pregnant mother features a prenatal ultrasound. But not all ectopic ureters are swollen, so other tools could also be better for a transparent diagnosis.

Urinary Tract Infection

Poor drainage from an ectopic ureter may make children more likely to possess UTIs. A UTI is when bacteria gets into the urine and travels up to the bladder. It becomes painful to urinate.

Vesicoureteral Reflux (VUR)

In boys with an ectopic ureter, there can also be a small flaw within the ureter. This can result in VUR. VUR is when some urine flows backward into the kidney when the bladder fills or empties. This makes the risk of kidney infections higher. It is another reason some children with ectopic ureters show signs of a UTI.

Treatment

The treatment for ectopic ureter is surgery. To prevent infection, the patient could also be placed on a coffee dose of antibiotics before surgery. The 3 sorts of surgery to repair this problem are:

Ø  Nephrectomy

Ø  Ureteroureterostomy

Ø  Ureteral reimplantation

Each option has pros and cons. They are also done at certain ages. Nephrectomy can be done any time. But if there's no infection, surgery are often postpone until the age of 6 months. Some surgeons wish to wait until a toddler is even older, often after the primary birthday, for ureteral re-implantation.

Nephrectomy (upper pole heminephrectomy)

In this surgery, the kidney (or the part of it drained by the ectopic ureter) is removed. This stops the flow of urine into the ectopic ureter. Now there will be no more incontinence, and less chance of infection.

This is an honest method when the kidney (or the a part of it) draining through the ectopic ureter isn't working well. It may also be used when that part of the kidney works well and the other kidney is normal. The surgeon may use laparoscopy (surgery using keyhole-sized incisions and long, chopstick-like instruments) since most of the abnormal ureter are often removed.

The main risks of this surgery are that good kidney tissue could also be removed, or the blood supply could also be injured. If there's no VUR into the ectopic ureter, there's less risk for infection.

Ureteroureterostomy

For this surgery, the ectopic ureter is split near the bladder. It is then sewn into the traditional ureter of the lower kidney. This lets the urine from the upper a part of the kidney drain normally. The kidney tissue is also protected.
The risk of harm to the lower ureter is extremely small with this surgery. There is a small risk of urine leak. If a short lived internal drainage stent (tube) is placed, more anesthetic could also be wont to remove it.

Ureteral Re-implantation

For this surgery, the ectopic ureter is split near rock bottom and sewn into the bladder. This is done in order that urine drains well and doesn't flow backwards. This surgery often requires a cut above the pubis .

This method features a slightly higher chance of problems than the opposite surgeries. It are often difficult to perform in small infants. The surgeon must make the ureter smaller, so there's less risk of VUR afterward. This increases the risk of blockage. But like ureteroureterostomy, this operation preserves all kidney tissue.

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