UroToday.com - Young girls who present with continuous urinary incontinence, and an otherwise normal voiding pattern after toilet training, should be considered as possibly having an ectopic ureter. In the strictest sense, an ectopic ureteral orifice is located anywhere except the normal trigonal position, but most often implies a more caudal insertion. Ureteral ectopia is believed to originate during development when the ureteral bud arises from the mesonephric duct in an abnormal, often proximal, location.

Ectopic ureters can be associated other congenital anomalies, such as imperforate anus, tracheoesophageal fistula, duplicated vagina, and bicornuate uterus. However, ureteral ectopia is often associated with renal maldevelopment. Renal dysplasia is believed to be due to abnormal interactions between the ureteral bud and metanephric blastema during development-the more remote the ureteral orifice, the greater the degree of renal dysplasia.

Small dysplastic kidneys are often difficult to diagnose with conventional imaging techniques. This is particularly true for those renal moieties in abnormal locations. Although often utilized first, ultrasonography and DMSA renal scintigraphy may not provide the necessary sensitivity to find a poorly functioning, ectopic dysplastic kidney. In the case of a dysplastic renal moiety with an ectopic ureteral insertion resulting in continuous urinary incontinence, early and accurate assessment helps to avoid the misguided treatments and frustration sometimes associated with delayed diagnosis.

This case report illustrates the utility of MRI in the diagnosis, preoperative planning, and intraoperative localization of an ectopic, dysplastic kidney associated with an ectopic ureter. MRI techniques have been shown to effectively assess renal anatomy, differential function, and ureteral ectopia in cases where renal scarring, ectopia, and dysplasia might otherwise challenge conventional imaging techniques (e.g., ultrasonography, DMSA, IVU, VCUG, CT), many of which involve exposure to ionizing radiation. MRI is able, furthermore, to provide a global overview of the malformations with enough detail (higher contrast and spatial resolution) to correctly predict subsequent intraoperative anatomic findings of the kidneys and ureters.

Written by David T. Duong, MD and Linda M.D. Shortliffe, MD as part of Beyond the Abstract on UroToday.com

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