Volume 13, Supplement 1
Original Article / Published: April 2025
DOI: https://www.doi.org/10.57045/jemis/1310425.pp14-15
E. Atanasov , Iv. Al. Georgiev , S. Andreev , M. Tsanev
“VITA“ Hospital, Urology Department, Sofia
Abstract
Introduction: An ectopic ureter is an anomaly in which the ureter has a non-orthotopic distal insertion (not in the bladder trigonum). It has incidence of 1:4000, and it is two to three times more frequent in women. 80% of women with an ectopic ureter have a duplex kidney, and in 80% of the cases the ectopic ureter originates form the upper pole. In 69% of the cases the ectopic ureter has an insertion in the bladder neck or in the urethra, in 31% in the vagina. In men – the insertion is in the posterior urethra – 57%, seminal vesicles – 33%, and vas deferens – 10%. The ectopic ureter can be obstructive and therefore cause hydroureteronephrosis of the kidney pole or non-obstructive often refluxing, causing urinary tract infections. A common symptom in women is urinary incontinence
Objectives: Presentation of laparoscopic treatment of an eleven-year-old girl with a left duplex kidney with ectopic ureter and hydroureteronephrosis of the upper pole. A terminolateral ipsilateral uretero-uretero anastomosis was performed.
Materials and methods: At the age of one upper pole hydronephrosis was found during routine US examination. No further diagnostic evaluation was done, because of the lack of symptoms, the child was followed up only by US by a nephrologist. Currently, ultrasound revealed loss of parenchymal tissue of the upper pole of the left kidney in comparison to previous studies. The anatomy and functionality of the urinary tract were examined using CT Urography, Systoscopy, RPG and VCUG. We started with a cystoscopy – a glide wire and a JJ stent 6CH/24cm were introduced into the ureter draining the lower pole of the duplex kid- ney (the JJ stent had a magnetic end (Magnetic Black-Star), a urethral catheter was inserted. Using three 5 mm ports, a 30-degree camera, the ectopic ureter on the left side was dissected transperitoneally at the level of the iliac vessels. The distal part was cut off to the level of the bladder neck, the normal ureter was located and terminolateral uretero-uretero anastomosis was performed with a running 5-0 monofilament suture (Monocril) ( 13 mm needle). Repositioning of the JJ stent in the ectopic ureter, draining the upper pole, was done under visual control. The urethral catheter was kept postoperatively for 24 hours.
Results: No intra- and postoperative complications were observed. No draining tubes were required. The operative time was 270 minutes. The hospital stay was 4 days. Removal of the JJ stent was performed after 6 weeks using a magnetic end catheter. Control ultrasound was performed in the first month after removal of the JJ stent.
Discussion: The ectopic ureter is a rare and sometimes difficult to diagnose. The symptoms depend on the insertion of the ureter and the sex of the child. One should consider the possibility of its presence in case of urinary incontinence (dribbling) with normal uroflow, recurrent urinary tract infections, dysplasia or hydronephrosis of the upper renal pole, lumbar pain. Laparoscopic treatment in these cases leads to a shortening of the hospital stay, minimal trauma, excellent aesthetic result and less pain in the postoperative period.
References
- Biles MJ, Finkelstein JB, Silva MV, Lambert SM, Casale P. Innovation in robotics and pediatric urology: robotic ureteroureterostomy for duplex systems with ureteral ectopia. J Endourol. (2016) 30: 1041–8. 10.1089 / end.2015.0645
- The Kelalis-King-Belman, Textbook of Klinical Pediatric Urology, sixth edition, chapter author – Michael A Keating, p.631
Keywords:
benign prostatic hyperplasia, holmium laser enucleation, en-bloc technique, 3-lobe technique.
How to cite this article:
E. Atanasov , Iv. Al. Georgiev , S. Andreev , M. Tsanev Laparoscopic terminolateral ipsilateral uretero-uretero anastomosis in child with urine ureteral ectopy of duplex kidney and urine incontinence Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2025; 13(1): 14-15
Corresponding author:
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VITA“ Hospital, Urology Department, Sofia
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