Case Presentation Ectopic Ureter

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Case Presentation


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The condition started 5 ys. Ago

Recurrent attacks.Patient asked medical advice several times and

received medical ttt for UTI & chronic prostatitis

several times.


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Operations

Medical illness

Bilhariziazes

TB

Stone passage

-Ve


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Abdominal & ext. Genitalia NAD

DRE Soft tender prostate


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CBC -------- NAD

Kidney & Liver Function ------- NAD

Urine:

Pus cells : 8-10

Ca Oxalate: +


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Culture & Sensitivity For Urine & EPS

Nogrowth

Nogrowth

Nogrowth


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KUB------ NAD

US --------- Non visualized

Rt. Kidney in its normal

position but cystic swelling

at the pelvis beside UB ??

Hydronephrotic ectopic

Kidney


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KUB------ NAD

US --------- Non visualized

Rt. Kidney in its normal

position but cystic swelling

at the pelvis beside UB ??

Hydronephrotic ectopic

Kidney


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IVU ------- Non visualized

Rt. Kidney with

compensatory hypertrophy

of left kidney


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IVU ------- Non visualized

Rt. Kidney with

compensatory hypertrophy

of left kidney


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Isotope Scan

No Rt. Renal perfusion

Adequate function of Lt.

Kidney.

Adequate compensatory

power of Lt. Kid. For the

complete loss of Rt. Renal

function.


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Isotope Scan

Global GFR = 70 ml/m

Lt. GFR = 70 ml/m


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CT Scan

Non visualized Rt. Kid.

Hypertrophied Lt. Kid.


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CT Scan

A 5x6 cm cystic structure

at the Rt. Side of the

pelvis displacing the Rt.

Aspect of the UB.

No evident contrast

enhancement.


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CT Scan




Aspect of the UB.

No evident contrast

enhancement.


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CT Scan




Aspect of the UB.

No evident contrast

enhancement.


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CT Scan




Aspect of the UB.

No evident contrast

enhancement.


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A R E T H E S E F I N D I N G S R E S P O N S I B L E F O R

P A T I E N T S Y M P T O M S ?

The question is ??????


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Mucinouscyst of a Seminal Vesicle Associated with Ectopic Ureter andIpsilateral Renal Agenesis


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Ectopic ureters

Ectopic ureters occur in 0.025% of the population.

Approximately 10% are bilateral.

Ectopic ureters occur more frequently in females than in males (by a

ratio of 6:1).

In females, more than 80% of ectopic ureters drain duplicated systems.

In males, most ectopic ureters drain a single system.

Approximately 80% of all ectopic ureters drain the upper pole of a

duplex kidney.


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In males: the ureters may terminate at :

bladder neck/prostatic urethra (48%)

seminal vesicle (40%) ejaculatory duct (8%)

vas deferens (3%)

epididymis (0.5%)

In females, the ureters may terminate at :

bladder neck/urethra (35%)

vestibule (30%)

vagina (25%)

uterus (5%).


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pathophysiology


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Etiology

A ureteral bud, branches off from the caudal portion of the wolffian

(mesonephric) duct between the fourth and sixth week of gestation.

The cranial portion of the ureteral bud joins with the metanephric

blastema and begins to induce nephron formation. The bud

subsequently branches into the renal pelvis and the calyces and

induces nephron formation.

the mesonephric duct (along with the ureteral bud) is incorporated

into the cloaca as it forms the bladder trigone. Alterations in budnumber, position, or time of development result in ureteral

anomalies.


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Ectopic termination of a single system or of the ureter of a duplex

system is the result of the high (cranial) origin of the ureteral bud

from the mesonephric duct. Because of the delayed incorporation of

the ureteral bud into the bladder, the resulting position of the

ureteral orifice is more caudal and medial.

Ectopia in these areas may be associated with reflux or

obstruction, and this is the suggested cause of renal functional

impairment or absence . So, seminal vesicle cysts are

commonly associated with renal agenesis or dysgenesis on the

ipsilateral side


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Case Presentation Ectopic Ureter

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