Ureteral Duplication, Ureteral Ectopia, and Ureterocele Follow-up

  • Author: John M Gatti, MD; Chief Editor: Marc Cendron, MD   more...
 
Updated: Aug 11, 2011
 

Further Outpatient Care

  • Postoperative radiographic imaging with ultrasonography and voiding cystourethrography (VCUG) is warranted to ensure the successful treatment of reflux and the absence of any obstructive element.
  • Postoperative residual hydronephrosis that may persist for years, even in the absence of obstruction, is common. Imaging is usually repeated serially until the hydronephrosis resolves or stabilizes.
  • Patients with renal scarring or dysplasia should be observed by their primary care physician with annual blood pressure assessment and urinalysis to rule out proteinuria.
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Complications

  • Short-term complications include urinary tract infection, hematuria, and, rarely, significant blood loss.
  • Long-term complications include recurrence of reflux and, more rarely, ureteral obstruction.
  • Heminephrectomy carries some risk of devascularization of the adjacent lower pole moiety, with loss of some or all of its function. Fortunately, this is uncommon.
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Prognosis

  • The ultimate prognosis of duplicated ureter, ureteral ectopia, or ureterocele is excellent.
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Contributor Information and Disclosures
Author

John M Gatti, MD  Associate Professor and Director of Minimally Invasive Urology, Department of Pediatric Surgery and Urology, Children's Mercy Hospital; Assistant Professor, Department of Pediatric Surgery and Urology, University of Missouri School of Medicine at Kansas City, Missouri; Assistant Clinical Professor, Division of Pediatric Urology, University of Kansas School of Medicine at Kansas City, Kansas

John M Gatti, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Urological Association, Society for Fetal Urology, and Society for Pediatric Urology

Disclosure: Nothing to disclose.

Coauthor(s)

J Patrick Murphy, MD  Professor of Surgery, University of Missouri at Kansas City School of Medicine; Section Chief of Urological Surgery, Children's Mercy Hospital

J Patrick Murphy, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Urological Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey F Williams, MD  Consulting Staff, Private Practice Urologist

Jeffrey F Williams, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Harry P Koo, MD  Chairman of Urology Division and Director of Pediatric Urology, Professor of Surgery, Virginia Commonwealth University School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond

Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Bartley G Cilento, Jr, MD  Instructor, Department of Surgery, Division of Urology, Children's Hospital of Boston and Harvard Medical School

Bartley G Cilento, Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin David Bomalaski, MD, FAAP  Pediatric Urologist, Alpine Urology

Martin David Bomalaski, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, and American Urological Association

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Marc Cendron, MD  Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology

Disclosure: Nothing to disclose.

References

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Ectopic ureter. Cystoscopic view of an ectopic ureter entering the bladder neck.
Single-system ectopic ureter. A retrograde pyelogram of the ectopic ureter opacifies the dilated system. The ureter is obstructed when the sphincter is closed but opens to drain when the sphincter opens during voiding.
Ectopic ureter to urethrovaginal septum. This patient presented with continuous drip incontinence. The blue catheter is positioned in the urethra. The gray catheter is positioned in the orifice of the ectopic ureter.
Duplicated ectopic ureter to the urethrovaginal septum. Retrograde injection of contrast into the orthotopic lower pole (white arrow) ureteral orifice and ectopic upper pole (black arrow) orifice simultaneously opacifies both systems.
A large ureterocele is seen as a filling defect on the early filling images of this cystogram.
Bilateral single-system ureteroceles. The collecting systems and their associated ureteroceles are opacified on intravenous pyelography (IVP). Multiple stones in the ureteroceles may be discerned within the ureteroceles (white arrows) as filling defects.
Bilateral ureteroceles with stones. This ultrasonogram at the bladder level depicts thin-walled, bilateral ureteroceles. Echogenic stone material can be seen in the left ureterocele.
Left duplicated kidney with upper pole ureterocele. This renal scan shows the typical findings of an upper pole duplicated system subtended by a ureterocele. The left upper pole (black arrow) shows minimal uptake when compared with the left lower pole or right kidney.
Renal duplication. Marked upper pole hydronephrosis with minimal dilation of lower pole, indicative of a duplicated collecting system.
Reflux into lower pole: A voiding cystourethrography (VCUG) that demonstrates reflux into the lower pole ureter with classic "drooping lily" configuration.
Female infant with acute pyelonephritis. The ultrasonography findings are notable for left hydronephrosis.
 
 
 
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