謝享宸、賴谷順、裘坤元、陳正哲

台中榮民總醫院 外科部 泌尿外科

Hsiang-Chen Hsieh, Gu-Shun Lai, Kun-Yuan Chiu and Cheng-Che Chen

Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan

 

Introduction: Ectopic ureter is diagnosed when any ureter that does not enter the trigonal area of the bladder. 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. In females, the ectopic ureter may enter anywhere from the bladder neck to the perineum and into the vagina, uterus, and even rectum. In males, the ectopic ureter always enters the urogenital system above the external sphincter or pelvic floor and usually into the wolffian structures. In this report, we present a special case about ectopic ureteric bud remnant at scrotum.

 

Case Report: A 41-year-old male presented to the outpatient department with intermittent turbid fluid from scrotum. On physical examination, a pinhole over left side scrotum with squeezing pain and discharge was noted. Anal fistula was ruled out by digital rectal examination, and urethra-cutaneous fistula was also excluded by cystourethroscopy, but disappeared left ureteral orifice was incidentally noted. Computed tomography revealed agenesis of left kidney, and a cystic lesion over left side scrotum. Because of repeat infection, the patient underwent resection of infectious sinus. The wound was deepened along with the sinus until to pubic bone. Near the tail of sinus, it connected to a tubule-like structure. Retrograde ureterography revealed blind end of this tubule-like structure. The direction of this tubule is compatible with the development of left ureter. The tube was ligated and the pathology diagnosis confirmed left ureteric bud remnant.

 

Discussion: The ectopic orifice is always found along the pathway of the developing mesonephric system. In males, the most common site is the posterior urethra, occurring in approximately 50 percent of cases. Other sites include the seminal vesicle, vas deferens, bladder neck, prostate to the level of the ejaculatory duct orifice and epididymis. Males with an ectopic ureter do not have urinary incontinence, but typically present of symptomatic urinary tract infection. In our case, we found an tubule-like ectopic ureteric bud remnant from scrotum to pubic bone, which is compatible with the development of left ureter. However, the type of ectopic ureteric bud remnant is rarely common.

 

Conclusion: When approaching patients, which have discharge from scrotum, Ectopic ureter should be one of the differential diagnosis that could be considered.