Solinas Andrea, De Giorgi Franco, Frongia Mauro
Department of Renal Pathology, Unit of Urology, San Michele Hospital, Cagliari, Italy.
Arch Ital Urol Androl. 2004 Sep;76(3):117-8.
Ureteral ectopy into the vagina is a cause of pseudo-incontinence. When the corresponding kidney has a good function, the treatment of choice is the ureter reimplantation, otherwise the alternative is partial or total nephrectomy. To report a case of 18-year-old girl presented with urinary leakage occurring between normal voids that at 11-year-old was found to have, at cistoscopy and vaginoscopy, an left ureteral ectopy into the vagina with a non demonstrable corresponding kidney at conventional intravenous urography, dimercaptosuccinic acid scintigraphy and ultrasonography. Moreover the right kidney was found enlarged but normally located. Her parents refused the explorative laparotomy to localize and to remove the left kidney. We completed the examination with computed tomography that revealed a small hypoplastic and ectopic left kidney located at L4 level. Because the contribution of the hypoplastic kidney to the total renal function was insignificant, we decided to eliminate it. A selective embolization of the left renal artery was performed using polyvinyl alcohol foam. The pseudo-incontinence stopped immediately after The patient was discharged home in II postoperative day and has been free from any leakage for 3 years. Serum creatinine levels and blood pressure returned to their normal values.
输尿管异位开口于阴道是假性尿失禁的一个原因。当相应肾脏功能良好时，首选治疗方法是输尿管再植术，否则可选择部分或全肾切除术。报告一例18岁女孩，表现为正常排尿间隙出现漏尿，11岁时经膀胱镜和阴道镜检查发现左输尿管异位开口于阴道，传统静脉肾盂造影、二巯基丁二酸闪烁扫描和超声检查均未发现相应的肾脏。此外，发现右肾增大但位置正常。她的父母拒绝行剖腹探查术来定位和切除左肾。我们通过计算机断层扫描完成了检查，结果显示一个小的发育不全的异位左肾位于L4水平。由于发育不全的肾脏对总肾功能的贡献微不足道，我们决定将其切除。使用聚乙烯醇泡沫对左肾动脉进行了选择性栓塞。栓塞后假性尿失禁立即停止。患者术后第二天出院回家，3年来一直无任何漏尿。血清肌酐水平和血压恢复正常。
