Diagnosis Of Ectopic Ureter As A Cause Of Urinary Incontinence

April 12, 2007 – 2:55 pm | posted in Pediatrics, Urology / Nephrology

UroToday.com- Hanson, et al evaluated the diagnosis of an ectopic ureter as a cause of urinary incontinence. One must always be aware that a completely potty trained girl with continuous drip incontinence may have an ectopic ureter inserting below the external sphincter. This diagnosis does present a challenge to prove at times. Typically an ultrasound and voiding cystourethrogram may help, but they are not always tell-tailing and further evaluation may be necessary. The group reviewed their experience with different imaging modalities used to make the diagnosis of ectopic ureters.

They reviewed the records of 24 girls with incontinence after potty training or other symptoms such as febrile UTI that led to the diagnosis of an ectopic ureter. They first focused on their initial imaging methods and then concentrating on the modality that provided the definitive diagnosis.

They had 24 patients with a total of 26 ectopic ureters. Two of the patients had bilateral ectopia. Interestingly 19 of these patients initially had a negative diagnostic workup from a radiologic standpoint. These tests consisted of 15 intravenous pyelograms, 18 VCUGs, 14 ultrasounds, 5 cystoscopies, 1 nuclear VCUG and 1 MRI. Two patients underwent computed tomography (CT) as the primary test revealing an ectopic system. Of the 26 ectopic ureters, the diagnosis was made by CT scan in 13, IVP in 5, cystoscopy in 6, and ultrasound in 1. One ectopic ureter was identified by exploration alone. It seemed that CT scan was the most sensitive and was very reliable to identify an ectopic system.

The group concluded that patients with an ectopic ureter may often have no abnormality on initial imaging studies. Their experience has shown that CT scan with delayed contrast seems to be the most sensitive, economic and readily available test for diagnosing ectopic ureters in these renal systems. We always have to be concerned about the amount of radiation that a child does receive with CT scans. Other imaging modalities, such as an MR urogram typically with 3D reconstruction if the software is available, seem to also have a high yield in my experience. Only once did the MR urogram not help in the light of a positive pyridium test. I had to explore that patient laparoscopically and did find an ectopic ureter to the urethra. I do agree with the group that CT scan is readily available and easy to interpret, but I caution only because of the amount of radiation that we may subject the very small children to for evaluation of this sometimes elusive entity.

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