Ectopic Ureter
An ectopic ureter is a congenital abnormality where the ureter does not insert into the bladder at the normal location, but instead empties into an abnormal site. This condition is often associated with duplicated urinary systems, especially in children and infants.
🧬 Pathophysiology
- In a normal urinary tract, the ureters insert into the bladder trigone.
- In ectopic ureter, the ureter bypasses the normal bladder insertion and drains into structures like:
- Urethra
- Vagina (in females)
- Vas deferens, seminal vesicle, or prostatic urethra (in males)
- Uterus or cervix (rare)
📊 Epidemiology
- More common in females
- Frequently associated with a duplicated collecting system
- Often affects the upper pole ureter in duplex kidneys
⚠️ Symptoms
In Females:
- Continuous urinary incontinence (despite normal voiding)
- Recurrent UTIs
- Hydronephrosis of the affected segment
In Males:
- Often asymptomatic, since the ectopic ureter usually inserts above the external sphincter
- May present later with infection, hematuria, or pain
🧪 Diagnosis
1. Ultrasound
- May show hydronephrosis or duplex kidney
2. Voiding Cystourethrogram (VCUG)
- To rule out associated vesicoureteral reflux
3. MRI Urogram or CT Urogram
- Best for defining ureteral anatomy and ectopic insertion site
4. DMSA Nuclear Scan
- Assesses differential renal function between upper and lower poles
5. Cystoscopy and Retrograde Pyelogram
- Direct visualization and confirmation of abnormal ureteral insertion
🩺 Treatment
✅ Depends on function of the ectopic segment:
1. If non-functional or poorly functional:
- Heminephrectomy (partial nephrectomy of the affected upper pole)
2. If functional:
- Ureteral reimplantation into the bladder
- Ureteroureterostomy – connecting ectopic ureter to the normal ureter (especially in duplex systems)
🧠 Key Association: Weigert-Meyer Rule
- In duplicated systems:
- Upper pole ureter → often ectopic, prone to obstruction
- Lower pole ureter → normal insertion, but prone to reflux
📈 Prognosis
- Excellent with appropriate diagnosis and surgical correction
- Untreated ectopic ureters may lead to:
- Persistent incontinence
- Recurrent infections
- Renal scarring or loss of function