History
No specific clinical signs are associated with ureteral anomalies. In most cases the anomaly is an incidental finding on a routine prenatal ultrasound, and the condition can be addressed before symptoms or infection develop. Some patients present with a urinary tract infection (UTI), abdominal mass, or hematuria. Children with primary megaureters may also present with cyclic abdominal pain/flank pain, or, less commonly, in acute pain crisis. [4] Patients may present with a cystic mass at the urethral meatus representing a prolapsed ureterocele. In other patients, the diagnosis is incidental after imaging studies for unrelated symptomatology.
Ureteral anomalies may be discovered during the evaluation of a patient with hypertension, proteinuria, or even renal insufficiency (in rare cases of severe bilateral anomalies).
Approximately 50% of females with ectopic ureters present with constant urinary incontinence or vaginal discharge. Consideration of an ectopic ureteral insertion should be given in prepubertal boys with recurrent epididymitis. Postpubertal males with ectopic ureters most commonly present with complaints of chronic prostatitis and painful intercourse and ejaculation. In males, incontinence is never due to an ectopic ureter because the ectopic ureter never inserts distal to the external urethral sphincter.
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Intravenous urogram demonstrating left primary megaureter in comparison to normal right collecting system.
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Ultrasound image of a normal right kidney in a child with a febrile urinary tract infection. Image courtesy of Steven Kraus, MD, Cincinnati, Ohio.
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Ultrasound image of the same patient (in Picture 2), demonstrating that the left kidney has a duplex collecting system. Note the lower-pole hydronephrosis. Image courtesy of Steven Kraus, MD, Cincinnati, Ohio.
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Voiding cystourethrogram from the same patient (in Picture 2), demonstrating right vesicoureteral reflux into a single system and left vesicoureteral system into the lower pole of a duplicated system. Note the deficiency of upper-pole calyces on the left side and the "drooping lily" appearance of the left lower-pole system, which suggest the duplication anomaly in this case. Image courtesy of Steven Kraus, MD, Cincinnati, Ohio.
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Voiding cystourethrogram that illustrates a right ureterocele characterized by the round filling defect at the right bladder base. Image courtesy of Steven Kraus, MD, Cincinnati, Ohio.
