Anastomosis of ectopic trifid ureter into the prostatic urethra with ureteropelvic reflux
Service d'Urologie, Centre Hospitalier Universitaire, Angers, France.Progrès en Urologie (Impact Factor: 0.66). 05/2006; 16(2):211-4.
Trifid ureter is a rare malformation with less than one hundred cases reported in the literature. However, like ectopic ureter, it is often asymptomatic and its real incidence is uncertain. The authors report a unique case of ectopic ureter draining into the prostatic urethra associated with trifid ureter, discovered during adulthood in a context of symptomatic ureteropelvic reflux. Laparoscopic assessment and treatment of this malformation are discussed, together with the hypotheses concerning its embryogenesis, based on a review of the literature.
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ABSTRACT: Introduction The objective of this study was to analyse the postopera-tive results of conservative management of functional ectopic ureter on duplicated collecting System by low uretero-ureterostomy in children. Materials and Method The medical records of children with duplicated collecting System and a functional ectopic ureter admitted to our department between 2001 and 2005 were reviewed. A postnatal radiological assessment comprising urinary tract ultrasound, retrograde cystography, intravenous urography and DMSA renal scintigraphy was performed. In each patient, the operative technique consisted of low uretero-ureterostomy with end-to-side uretero-ureteric anastomosis. Results This series comprised 3 girls and 2 boys. The ectopic ureter was located on the left side in all patients. Postnatal ultrasound confirmed the presence of dilatation of the upper collecting System and the retrovesical ureter estimated at 10 ± 2 mm in 3 cases; in one case, dilatation of the upper collecting System was estimated at 25 mm and the retrovesical ureter was estimated at 16 ±2 mm; in the last patient, dilatation of the upper collecting System above the retrovesical ureter was estimated at 6.5 mm. Mean renal function of the upper pole (DMSA) was 23 ± 7%. The mean age at the time of the operation was 8 months. The immediate postoperative course was uneventful in all patients. Mean follow-up was 38 months (range: 18 months to 4.5 years). All children were asymptomatic and a reduction of collecting System and ureteric dilatation was confirmed on follow-up ultrasound at 10 months in all patients. Conclusion Low uretero-ureteric anastomosis is an alternative to high collecting System anastomosis or ureteric reimplantation in the presence of a functional ectopic ureter on duplicated collecting System in children.
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