An ectopic ureter is when the lower end of the tube drains somewhere other than its normal location in the bladder. These abnormal locations may be inside or outside the bladder, such as the urethra. Some other locations outside the bladder include the prostate, urethra and seminal vesicles in boys and the vagina in girls.
It is not uncommon for the ectopic ureter to be associated with a ureter that drains the top portion of the kidney in a duplicated collecting system. There may also be a ureterocele or cystic dilation of the insertion site, which can be associated with obstruction or vesicoureteral reflux (VUR). Hydronephrosis (dilation of the kidney) can be seen if there is an associated element of obstruction or higher grades of VUR.
This may be identified on prenatal ultrasound before birth if associated with hydronephrosis or a ureterocele. A child may present with urinary tract infections that may occur in the setting of obstruction or vesicoureteral reflux. Sometimes girls present with continuous leakage of urine if the ureter exits outside the bladder in the vagina.
These patients are often evaluated with a renal bladder ultrasound, a voiding cystourethrogram, nuclear medicine renal scan or sometimes an MRI.
Treatment is always individualized and may include temporary drainage by bringing the ureter to the skin (ureterostomy), reinserting the ureter into the bladder (reimplantation) or other ureteral or kidney surgery. The surgeon will discuss various options based on the individual child’s findings.