- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
Ectopic ureter is diagnosed when the ureteral orifice is caudal to the normal insertion on the trigone of the bladder. In many instances, an ectopic ureter is not detected because the affected individual is asymptomatic. In other cases, especially in females, an ectopic ureter commonly presents with urinary incontinence; in both sexes, it may present as an antenatal diagnosis, urinary tract infection (UTI), or, rarely, urinary obstruction.
Ectopic ureter, including its pathophysiology, clinical presentation, diagnosis, evaluation, and management will be reviewed here.
An ectopic ureter forms when the origin of the ureteral bud from the mesonephric duct is abnormally high, and separation of the bud from the duct is delayed or does not occur (figure 1) . Ectopic ureters are commonly associated with a double (duplex) collecting system. In these cases, the double collecting system is thought to result from duplication of the ureteric bud. The cranial or superior ureteral bud is associated with the lower renal pole, and the caudal or inferior ureteral bud with the upper renal pole (figure 1 and picture 1). (See "Overview of congenital anomalies of the kidney and urinary tract (CAKUT)", section on 'Anomalies of the collecting system'.)
Ureteral orifice site — The ectopic orifice is always found along the pathway of the developing mesonephric system.
In the male, the most common site is the posterior urethra, occurring in approximately 50 percent of cases . Other sites include the seminal vesicle (approximately one-third), vas deferens, bladder neck, prostate to the level of the ejaculatory duct orifice, and epididymis (figure 2). The ectopic ureter is always above the external urinary sphincter. Therefore, males with an ectopic ureter do not have urinary incontinence, but typically present secondary to a prenatal diagnosis of hydroureteronephrosis or symptomatic urinary tract infection (UTI).
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- Ureteral orifice site
- Single versus duplex system
- CLINICAL PRESENTATION
- Prenatal presentation
- Postnatal presentation
- - Males
- - Females
- Other anomalies
- - Genitourinary
- - Other anomalies
- DIAGNOSIS AND EVALUATION
- Diagnostic tests
- Further evaluation
- Duplex system
- Single system
- SUMMARY AND RECOMMENDATIONS