Ectopic opening of ureter
Introduction
Introduction to ectopic ureteral opening The ureteral ectopic opening refers to the ureteral opening outside the normal position. Men are more likely to open in the posterior urethra, ejaculatory duct, seminal vesicle, etc., while women can open in the anterior urethra, vagina, vestibule and cervix, about 80% of the ureteral orifice. The ectopic is seen in the upper ureter in the double ureter. More than 80% of bilateral ureter and ureteral ectopic are seen in women. Single ureteral ectopic is more common in men, and about 10% of ureteral ectopic is bilateral. basic knowledge The proportion of illness: 0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: anal atresia, tracheoesophageal fistula
Cause
Etiology of ectopic ureteral opening
At the 4th week of the embryo, the ureteral bud protruding from the lower end of the middle kidney tube rapidly grows to form a ureter, and the distal end develops into a renal pelvis, renal pelvis and collecting duct; when abnormal, the middle kidney tube also emits a paraurethral bud, which rises side by side with the normal ureter bud. Not only the formation of a double ureteral malformation, but also because the lower part of the middle kidney tube forms part of the bladder and is transformed into the male urethra, seminal vesicle, ejaculatory duct, part of the female urethra, vestibule, vagina, uterus, etc., so the repeat ureter can open above Organs, the male anterior urethra is developed by the genitourinary sinus, so the male ureteral ectopic does not open to the distal side of the external urethral sphincter, so there is no dripping urine; while the female urethra is mainly formed by the lower end of the cloaca abdomen, so the female ureter is different The position can open to the distal side of the random sphincter to cause drips.
Prevention
Ureteral ectopic opening prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease. Pregnant women should pay attention to avoid contact with radioactive sources, toxic and harmful substances, so as not to affect the healthy development of the embryo and cause deformity. Pay attention to the prenatal examination and find that the abnormality can be considered as a termination of pregnancy.
Complication
Ureteral ectopic opening complications Complications, anal atresia, tracheoesophageal fistula
The ureteral ectopic often combined with other malformations, such as anal atresia, tracheoesophageal fistula, etc., occasionally in patients with isolated kidney.
Symptom
Ureteral ectopic opening symptoms common symptoms urinary incontinence eczema
Male ectopic ureteral orifices are mostly above the external sphincter, generally no obvious clinical symptoms, mainly urinary tract infections, can also produce varying degrees of lumbosacral pain and recurrent epididymitis, while women are mainly characterized by normal urination At the same time, there are persistent urinary incontinence and urinary tract infections, and the skin of the vulva is eczema and erosion. Careful examination can find small openings in the vestibule, vagina and urethra of women, and the urine continues to drip.
Examine
Examination of ectopic ureteral opening
In addition to the general surgical routine examination, special attention should be paid to the princess examination, and the ectopic ureteral opening should be carefully searched. For example, the ureteral catheter is inserted into the ureter with suspicious ectopic opening for angiography, but it is generally difficult to find.
When there is a urinary tract infection, white blood cells can be seen in routine urine examination, and urine culture can cause pathogenic bacteria to grow.
Venous urography
Can understand the type of ectopic ureteral opening and the position of the opening, the corresponding repetitive renal upper kidney development and water accumulation in the ectopic ureteral opening, can also understand the situation of complicated renal ureter.
2. CT examination
Can understand the size, shape, renal cortical thickness of the kidney, especially the case of undeveloped IVP.
3. Bladder urethroscopic examination and retrograde pyelography to see if there is an ectopic opening in the bladder.
Diagnosis
Diagnosis and diagnosis of ectopic ureteral opening
diagnosis
In addition to the general surgical routine examination, special attention should be paid to the princess examination, and the ectopic ureteral opening should be carefully searched. For example, the ureteral catheter is inserted into the ureter with suspicious ectopic opening for angiography, but it is generally difficult to find.
Differential diagnosis
Stress urinary incontinence
It is characterized by an increase in abdominal pressure (such as coughing, sneezing, running and other intense activities), urine involuntarily flowing out of the urethra, rather than continuous outflow of urine, no ectopic ureter can be found outside the bladder The opening, the urography showed the kidney, and the ureter was normal.
2. Bladder vagina
It is characterized by the continuous outflow of urine from the vagina. When the pupil is small, the bladder can still have normal urination. Therefore, it needs to be differentiated from the ectopic ureter. The patient usually has dystocia, gynecological examination or pelvic surgery, radiation therapy and other past history, vagina. Microscopic examination can be found in the pupil. If the pupil is small and the observation is unclear, gauze can be placed in the vagina, and methylene blue can be injected into the bladder through the catheter. If the gauze turns blue, the diagnosis can be confirmed, or the bladder can be injected. Umbilical glucagon for cystography, positive side slices, see contrast agent from the bladder into the vagina can be diagnosed, cystoscopy can be found in the bladder and the ureteral opening on both sides is normal.
3. Ureteral vaginal fistula
Also manifested as continuous outflow of urine from the vagina, mostly due to pelvic surgery, dystocia, ureteral tuberculosis, colposcopy can be found in the pupil, retrograde angiography from the pupil into the ureteral catheter can show renal pelvis and ureter, IVU examination showed no kidney pelvis Double ureteral malformation, and visible contrast agent into the vagina, cystoscopy showed bilateral ureteral opening is normal.
4. Neurogenic bladder
There is urinary incontinence, but there is a history of nerve damage or systemic disease; there is urinary retention, the bladder can be touched on the pubic bone, the nervous system checks the perineal and saddle area feelings diminished; IVU shows both kidney and ureteral hydrops, renal function Decreased, but no renal ureteral repeat deformity, no ectopic ureteral opening can be found outside the bladder.
