Hussen Nuru Bedru, Kumsa Ibsa Daba, Gebreamlak Abeselom Lemma
Addis Ababa University, College of Health Sciences, Depart of Surgery, Urology Unit, PO BOX: 9086, Ethiopia.
Int J Surg Case Rep. 2023 May;106:108234. doi: 10.1016/j.ijscr.2023.108234. Epub 2023 Apr 25.
Ectopic ureter is defined as any ureter, single or duplex, that opens in a location other than trigone of bladder. Continuous urine leakage and regular intentional voiding must point to the diagnosis of an ectopic ureter, particularly in females (Singh et al., 2022). Following successful repair of ectopic ureter, the overall long-term continence rate is satisfactory.
This case is reported to discuss a case of 24 yrs. old woman presenting with a complaint of insensible continuous urinary leak with normal intentional voiding since childhood. Ultrasound and CTU showed left solitary kidney with normal insertion of its ureter; but failed to demonstrate right system. MRI showed Right EU with ectopic dysplastic right kidney. Renal scintigraphy was unavailable at the time of evaluation and IVP was suggestive of NEK. Nephroureterectomy done. Her subsequent follow up was satisfactory.
Because many people with EU are asymptomatic and the diagnosis is frequently missed, the prevalence of EU is uncertain. Preferred mode of diagnosis is pelvic MRI. Ureteral duplication accounts for 80 % of ectopic ureter occurrences in women (Demir et al., 2015). Ectopic ureters draining a single-system ectopic ureter with dysplastic kidneys, on the other hand, are uncommon, particularly in females (Amenu et al., 2021) Despite this rarity, we have found single system with atrophic kidney.
This instance suggests to us that in cases of urinary incontinence especially in women, congenital anomalies of the genitourinary tract should be taken into consideration. Surgical management depends on the degree of renal function and location of EU. Either nephroureterectomy or ureteric reimplantation are curative for incontinence.
异位输尿管定义为任何一条（单支或双支）开口于膀胱三角区以外位置的输尿管。持续性尿液渗漏且有规律的自主排尿，这必须提示异位输尿管的诊断，尤其是在女性中（辛格等人，2022年）。异位输尿管修复成功后，总体长期控尿率是令人满意的。
本文报告一例24岁女性病例，自童年起就有不明原因的持续性尿失禁且自主排尿正常的主诉。超声和CT尿路造影显示左肾孤立且输尿管插入正常；但未显示右侧泌尿系统情况。磁共振成像显示右侧异位输尿管合并发育异常的右肾。评估时未进行肾闪烁显像，静脉肾盂造影提示肾发育不全。行肾输尿管切除术。她随后的随访情况良好。
由于许多异位输尿管患者无症状，诊断常常被漏诊，所以异位输尿管的患病率尚不确定。首选的诊断方式是盆腔磁共振成像。输尿管重复畸形占女性异位输尿管病例的80%（德米尔等人，2015年）。另一方面，引流单系统发育异常肾脏的异位输尿管很少见，尤其是在女性中（阿梅努等人，2021年）。尽管这种情况罕见，但我们发现了单系统合并萎缩肾的病例。
这个病例向我们表明，在尿失禁病例中，尤其是女性，应考虑到泌尿生殖道的先天性异常。手术治疗取决于肾功能程度和异位输尿管的位置。肾输尿管切除术或输尿管再植术均可治愈尿失禁。
