Introduction:
Ureter is part of the urinary system. It consists of two narrow tubes carrying urine from their respective kidneys to the bladder. In every individual, one ureter is usually attached to each kidney, and both connect towards one side of the bladder. Ectopia happens when a person is born with their ureters in the wrong position. This ureteral ectopia can cause swelling, infections, and urinary incontinence. However, it does not affect a person's ability to have children or their sexual function. Even though this condition is usually present from birth, it is still difficult to diagnose. This article will explain ureteral ectopia and how it can be managed.
What Is Ureteral Ectopia?
Ureteral ectopia is a congenital abnormality of the ureter. In this condition, the ectopic ureter carries the urine to places other than the bladder, like the neck of the bladder (the bottom portion of the bladder where the urine enters the urethra and leaves the body), urethra (tube leaving out of the bladder), cervix, uterus, or vagina in females, the seminal vesicles (male glands which produce semen ), ejaculatory ducts, vas deferens (male ducts that carry sperms) or the rectum (ending area of the large intestine which leads to the anus).
How Does Ureteral Ectopia Affect a Person's Body?
Ureteral ectopia causes urinary tract infections, where a person will experience pain while urinating. It also causes urinary incontinence or trouble controlling the bladder, causing the urine to leak. Another condition associated with ureteral ectopia is hydronephrosis. In this condition, the kidney becomes swollen since it cannot fully empty its contents. Very rarely, when severe cases are left untreated, an ectopic ureter can cause damage to the kidneys.
Who Is More at Risk for Ureteral Ectopia?
Anyone can be born with a ureteral ectopia. However, this congenital disability can occur in a person when either of their parents has had an ectopic ureter. This condition is usually seen more in girls than boys. Sometimes ureteral ectopia can occur alongside other structural abnormalities of the urinary system or kidneys.
What Causes a Ureteral Ectopia?
A ureteral ectopia has no specific cause. However, if this congenital abnormality runs in the family, the chances of children developing it are about 50 percent.
What Symptoms Are Seen in a Ureteral Ectopia?
In some persons, the condition can be asymptomatic. Other symptoms seen in a ureteral ectopia include urinary incontinence, frequent urinary tract infections, and swelling in the abdominal area caused by the condition of hydronephrosis. Very rarely, urinary obstruction is also noted.
How Is Ureteral Ectopia Diagnosed?
A ureteral ectopia can be diagnosed before birth during the prenatal ultrasound. Suppose the condition is not diagnosed through ultrasound, in that case, it will be difficult to be diagnosed later as many other conditions have the same signs and symptoms as the ectopic ureter. Even though this condition is present right from birth, it can be misdiagnosed or missed for many years. This condition is difficult and can also be difficult to diagnose since the affected individual can be asymptomatic.
- To diagnose ureteral ectopia, the healthcare providers will take a detailed history of the symptoms and how long a person has had them.
- The doctor will also enquire about family history, conduct a physical examination, and order urine tests to check for infection, and blood tests to test kidney function.
- Some other tests include:
1. Imaging Tests - Ultrasound, computed tomography scan (CT scan), and magnetic resonance imaging (MRI) are used to obtain detailed images of the urinary system.
2. Renal Flow Scan - This scan is done to determine the working condition of the kidneys and to check for any abnormalities. In this technique, the healthcare provider injects very small amounts of radioactive dye into the patient's body. A gamma camera then shows the flow of dye through the urinary system.
3. Cystoscopy - In this technique, the healthcare provider inserts a very thin tube containing a camera through the urethra to view the bladder area. This technique is usually used to examine the bladder and the urethra.
4. Urography - In this test, the health care provider injects a dye into the body to examine the urinary system. As the dye moves through the ureters, bladder, and kidney, imaging techniques like X-ray, CT scan, or MRI are used to take images of the uterus.
5. Voiding Cystourethrogram (VCUG) - A VCUG Is done to check for any abnormalities in the bladder or urethra area and determine whether a person has reflux. A reflux is when the urine tends to move back to the ureter into the kidneys. This can increase more chances of urinary tract infections.
How Is Ureteral Ectopia Managed?
Surgical intervention is the first-line treatment for ureteral ectopia. The surgery aims to rectify the congenital disability and drain the urine away from the kidney area to prevent any further damage. The outcome of people with ureteral ectopia after surgical management is usually good. Even if a part or the whole kidney is removed, the other remaining kidney can perform well and do the work. The different modalities of surgery used for the management of ureteral ectopia include:
Ureterostomy - The technique creates an opening in the skin surface of the abdominal area. The urine is then drained into a diaper or a pouch. This procedure usually requires a second procedure which has to be done later.
Ureteroureterostomy - In this procedure, a new connection is created to rectify the problem. For instance, the connection might connect the ectopic ureter to a normal ureter.
Ureteral Reimplantation - In this procedure, the ureter is attached to a correct position in the wall of the bladder.
Nephrectomy - It involves removing a part of the kidney (partial nephrectomy) or the entire kidney(radical nephrectomy). This procedure is used as a last option whenever low kidney function is noted, and the other kidney is healthy.
Can Ureteral Ectopia Be Prevented?
Ureteral ectopia cannot be prevented. This congenital abnormality usually runs in families, so it is recommended to perform tests to diagnose ureteral ectopia in the early stages.
Conclusion:
Ectopia is a congenital condition present right from birth. It can cause symptoms like abdominal swelling, recurrent urinary tract infections, and urinary incontinence. If left untreated, they can even cause damage to the kidneys. Ureteral ectopia can be diagnosed by a prenatal ultrasound or later in life. Even though ureteral ectopia is difficult to diagnose later, surgical intervention brings a good outcome in persons with this condition.
