雙套腎合併異位性輸尿管以持續性漏尿表現:案例報告及文獻討論
盧昱成、黃國皓、姜宜妮、張宏江
國立台灣大學醫學院附設醫院 泌尿部
Duplicated Kidney With Ectopic Ureter in a Girl presented With Persistent Incontinence: A Case Report and Review
Yu-Cheng Lu、Kuo-How Huang、I-Ni Chiang、Hong-Chiang Chang
Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Case Presentation
This is a 5-year-old girl who had suffered from urinary incontinence since birth. She had been following up at local clinics where observation was suggested till 3-year-old. The patient came to our hospital for second opinion and a suspicious orifice near right labia majora was noted. Renal ultrasound showed no bilateral hydronephrosis. Intravenous urogram on 2018/08/28 revealed grossly intact bilateral kidney. MRI on 2018/10/26 demonstrated suspicious left duplication kidney and a small left upper moiety with dilated abdominal and pelvic ureter.
The patient received cystoscopy on 2018/11/26, which did not find specific lesion in bladder but one ectopic ureteral orifice with clear urinary efflux was noted between urethra and vagina. However, it was too narrow for the ureteroscope. She received left laparoscopic ureteroneocystostomy on 2019/01/09. Left ectopic ureter, which was tortuous and dilated with periureteral adhesion, was reimplanted to the dome of bladder near posterior wall. A Fr. 6-20 cm double-J catheter was inserted into her left ectopic ureter to protect anastomosis wound. Complicated urinary tract infection with urine culture showed Pseudomonas aeruginosa occurred after operation. She recovered smoothly after judicious antibiotic treatment and left double-J catheter was removed two months later.
Discussion
The incidence of ectopic ureters is about 1 in 1900 cases and more commonly in females. Males with ectopic ureter are usually diagnosed when an evaluating the causes of repeated urinary tract infection and few male patients may present with epididymitis. Females usually present with incontinence and few female patients may have pyelonephritis. The majority of ectopic ureters are a duplex kidney, with incidence ranging from 70 to 90 percent.
Renal ultrasound may show dilated ureter at upper pole and bladder ultrasound may show ureterocele. CT and MRI are the most sensitivity tools to detect ectopic ureter and duplicated kidney. VCUG, DSMA and Tc99m-MAG3 can provide more information before surgical intervention. Ureteral reimplantation, partial nephrectomy or ureteroureterostomy are options of surgery. Surgical outcome is usually excellent and symptoms resolved in most cases.