Jain Pritesh, Sarkar Debansu, Maiti Krishnendu, Gupta Sandeep, Pal Dilip Kumar
Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
Turk J Urol. 2019 Dec;45(Supp. 1):S92-S97. doi: 10.5152/tud.2018.37085. Epub 2018 Nov 21.
Purpose of our study was to aggregate and analyse rare cases of Ectopic Ureter (EU), their association with other anomalies, clinical features, diagnosis and management.
A total of nine patients with rare presentation of EU were evaluated. Combination of endoscopic and imaging modalities was used as required to define the anatomy and devise the best surgical approach in these cases.
Among six females and three males with EU, four cases had bilateral EU, four unilateral EU and one case had EU of a solitary kidney. Urinary incontinence was encountered in five cases including one male patient whilst other cases presented with varied clinical features and associated anomalies. Two patients had anorectal malformations, and two had uterine anomalies in the form of bicornuate uterus. Other patients had multiple rare associations such as triplication of ureter, bilateral absence of seminal vesicles with infertility, multicystic dysplastic kidney, ureter draining in uterus, renal failure, absence of bladder trigone, and hypospadias etc. Ureteric reimplantation was performed in four cases, two required ureteroureterostomy, another two had undergone upper pole nephrectomy and in one case renal transplant had been carried out owing to chronic renal failure.
EU is among group of those congenital entities which remain shrouded until adulthood, when symptoms become distressing. Fortunately, prognosis is favourable after surgical correction, in spite of its rarity. Complexity arises when other associated anomalies are identified.
我们研究的目的是汇总并分析罕见的异位输尿管(EU)病例、其与其他异常的关联、临床特征、诊断和治疗。
对总共9例表现罕见的EU患者进行了评估。根据需要采用内镜和影像学检查相结合的方式来明确解剖结构,并为这些病例设计最佳手术方案。
在6例女性和3例男性EU患者中,4例为双侧EU,4例为单侧EU,1例为孤立肾的EU。5例出现尿失禁,其中包括1例男性患者,其他病例表现出各种临床特征和相关异常。2例患者有肛门直肠畸形,2例有双角子宫形式的子宫异常。其他患者有多种罕见的关联情况,如输尿管重复、双侧精囊缺如伴不育、多囊性发育不良肾、输尿管引流至子宫、肾衰竭、膀胱三角区缺如和尿道下裂等。4例行输尿管再植术,2例需要输尿管输尿管吻合术,另外2例接受了上极肾切除术,1例因慢性肾衰竭进行了肾移植。
EU属于那些直到成年症状变得令人痛苦时才被发现的先天性疾病。幸运的是,尽管其罕见,但手术矫正后的预后良好。当发现其他相关异常时会出现复杂性。