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Case Reports
. 2020 Aug 26;13(8):e234915.
doi: 10.1136/bcr-2020-234915.

Dismembered extravesical reimplantation of ectopic ureter in duplex kidney with incontinence

Abhishek Chandna  1 , Pawan Kaundal  1 , Kalpesh Mahesh Parmar  1 , Shrawan Kumar Singh  2
Affiliations
Case Reports

Dismembered extravesical reimplantation of ectopic ureter in duplex kidney with incontinence

Abhishek Chandna et al. BMJ Case Rep. .

Abstract

Ectopic ureter is a rare but pertinent cause of incontinence in young women. We report a 12-year-old girl who presented with reports of incontinence since birth. She was evaluated and found to have complete duplication of the left ureter, with the upper moiety ureter opening into the vestibule of the vagina just below the external urethra meatus. She was managed surgically by dismembered extravesical reimplantation of the upper moiety ureter instead of the conventional method of common sheath reimplantation, sparing the patient a wide cystostomy and intravesical dissection. One year postsurgery, the patient is asymptomatic and dry. Dismembered reimplantation of the ectopic ureter is a simple and reproducible technique which avoids manipulation of the normal lower moiety ureter and its associated potential complications. At the same time, it ensures that the patient is dry without any adverse effect on the lower moiety or its ureter.

Keywords: urological surgery; urology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Voiding cystourethrogram demonstrating a normal bladder with a capacity of 300 mL and no reflux. (B) Reconstructed image of CT urography demonstrating duplex left kidney. (C) Ectopic ureter traversing behind the bladder into the pelvis. (D) Ectopic ureter going down into the perineum.
Figure 2
Figure 2
(A) Ectopic ureteric orifice with orange-tinged urine due to phenazopyridine is obvious (thick arrow); normal external urethral meatus (thin arrow). (B) Ectopic ureteric orifice permitting 8 Fr infant feeding tube.
Figure 3
Figure 3
(A) Division of the common sheath demonstrating the dilated ectopic ureter (black arrow) and normal lower moiety ureter (white arrow). (B) Ectopic ureter dissected off the normal ureter. Mucosa of the bladder is seen pouting through the tunnel (white arrow). (C) Bleeding from the proximal cut end of the ectopic ureter (white arrow). (D) Ureter decompressed and posterior layer of the vesicoureteral anastomosis completed.
Figure 4
Figure 4
(A) and B) Postoperative axial CT scan films demonstrating course of the ectopic ureter into the bladder.
See this image and copyright information in PMC

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