Embryology of the urogenital tract; a practical overview for urogynecologic surgeons

Abstract

Introduction and hypothesis: Urinary tract anomalies are one of the most common birth defects. Nevertheless, they prove challenging to diagnose as a result of variable presenting symptoms. We aimed to perform a review of urogenital tract development, highlight common congenital upper urinary tract anomalies encountered by urogynecologists and tools to facilitate diagnosis.

Methods: Multiple searches were performed utilizing resources such as PubMed and the TriHealth library database to access publications related to embryology of the urinary tract and urinary tract anomalies. Each citation was reviewed.

Results: Congenital urinary tract anomalies account for up to 20% of all birth defects and occur more often in females. The true incidence of these malformations is unknown as some can remain clinically insignificant throughout life. In addition, patients may present with non-specific complaints such as urinary tract infections, nephrolithiasis or urinary incontinence. Therefore, unsuspected anomalies pose a risk of delayed diagnosis and potential injury during urogynecologic surgery. Imaging modalities such as computed tomography or magnetic resonance imaging are the most common diagnostic tests. Management and treatment options range from observation to surgical resection with the goal of optimizing long-term functionality and prevention of chronic sequelae.

Conclusion: Patients with urinary tract anomalies can present with vague complaints often encountered by urogynecologists. It is crucial to understand the embryologic development of urinary tract anomalies to help facilitate diagnosis and guide care within the office and operating room setting.

Keywords: Ectopic ureter; Embryology of the urinary tract; Pelvic kidney; Ureteral duplication; Ureterocele; Urinary tract anomalies.