Bilateral single ureteral ectopia: difficulty attaining continence using standard bladder neck repair.

PURPOSE

We reviewed the surgical results of the management of bilateral single ureteral ectopia, a rare congenital cause of severe urinary incontinence.

MATERIALS AND METHODS

We reviewed the records of 6 girls and 1 male infant who presented to 1 institution with this diagnosis in a 10-year period.

RESULTS

All patients were incontinent and 3 had undergone ureteral reimplantation as an initial procedure with persistent postoperative wetting. Of the 5 patients who underwent a total of 8 attempts at increasing bladder outlet resistance, including 3 Young-Dees-Leadbetter, 2 Kropp, 1 Stamey, 1 Burch and 1 pubovaginal sling procedure, 2 also underwent simultaneous bladder augmentation to increase bladder capacity. However, none of these children had satisfactory continence after the continence procedure. Three of these patients who subsequently underwent appendicovesicostomy with bladder neck closure are continent. The 2 remaining patients underwent initial appendicovesicostomy with bladder neck closure and augmentation, and they are also continent.

CONCLUSIONS

In our series total day and nighttime continence was only achieved by bladder neck closure, appendicovesicostomy and augmentation. Attempts at increasing bladder outlet resistance in patients with bilateral single ectopic ureters led to suboptimal rates of success even when adequate bladder capacity had been ensured by simultaneous augmentation.