Ureter là gì

Most of us are born with 2 ureters, the tube that drains the urine from each kidney into the bladder.

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But some babies are born with 2 ureters that drain a single kidney. In these cases, one ureter drains the upper part of the kidney and the second ureter drains the lower part of the kidney. As long as they both enter the bladder, this extra ureter is usually not a problem.

But if a child is born with a ureter that does not connect with the bladder, it can drain somewhere outside the bladder. This is called an ectopic ureter. In girls, the ectopic ureter can drain into the urethra (the tube leading out of the bladder that we use to lớn pee out of) or even the vagimãng cầu. In boys, it often drains into lớn the urethra near the prostate or into the sex organs.


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Diagram of Ectopic UreterEnlarge

Causes


There are no known causes for this birth defect. This extra ureter just develops from a single kidney. It can happen in boys or girls, but is more comtháng in girls. There is also no proof that something during pregnancy causes it.

It is known to be hereditary (passed down in a family). If you had an ectopic ureter, then each of your children has a one-half chance of having this duplicated system.


Symptoms


The general signs of ectopic ureter are:

Swelling in the abdomen

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Incontinence

A blocked ureter or incontinence (leaking urine) can be signs of an ectopic ureter.

Boys with ectopic ureters vì chưng not often have sầu incontinence, since the ureter drains inside the toàn thân. But they may still have sầu signs of swelling or a UTI.Girls with ectopic ureters may leak urine since the ureter drains into or near the vagina. This problem is clear after toilet training. It is unlike other types of incontinence. Instead, there is a general, all-over moistness rather than events where the bladder looses control. Some girls will be treated with drugs and other things for many years before the right diagnosis is made.Swelling

The ureter và part of the kidney can swell when it cannot drain properly. This is called hydronephrosis and it is easy khổng lồ see on ultrasound.

In many babies, an ectopic ureter is found when the pregnant mother has a prenatal ultrasound. But not all ectopic ureters are swollen, so other tools may be better for a clear diagnosis.

Urinary Tract Infection

Poor drainage from an ectopic ureter may make children more likely to have UTIs. A UTI is when bacteria gets inkhổng lồ the urine & travels up lớn the bladder. It becomes painful khổng lồ urinate.

Vesicoureteral Reflux (VUR)

In boys with an ectopic ureter, there may also be a slight flaw in the ureter. This can result in VUR. VUR is when some urine flows backward into lớn the kidney when the bladder fills or empties. This makes the risk of kidney infections higher. It is one more reason some children with ectopic ureters show signs of a UTI.


UltrasoundBladder X-ray (Voiding Cystourethrogram, or VCUG)Renal Flow Scan (MAG-3 or DMSA) or Magnetic Resonance UrogramThe kidney or part of the kidney drained by the ectopic ureter often doesn’t work well. In these tests, contrast dye liquid is injected. A special camera is used to spot radioactivity in the dye. MRI (magnetic resonance imaging) can also be used.Cystoscopy

But if the ureter is not swollen and there is no reflux, the ultrasound & VCUG may be normal. MRI and CT scan are better at finding slight swelling of the ureter and the part of the kidney it drains.


The treatment for ectopic ureter is surgery. To prevent infection, the patient may be put on a low dose of antibiotics before surgery. The 3 types of surgery khổng lồ fix this problem are:

NephrectomyUreteroureterostomyUreteral reimplantation

Each option has pros and cons. They are also done at certain ages. Nephrectomy can be done any time. But if there is no infection, surgery can be put off until the age of 6 months. Some surgeons like khổng lồ wait until a child is even older, often after the first birthday, for ureteral re-implantation.

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Nephrectomy (upper pole heminephrectomy)

In this surgery, the kidney (or the part of it drained by the ectopic ureter) is removed. This stops the flow of urine inkhổng lồ the ectopic ureter. Now there will be no more incontinence, và less chance of infection.

This is a good method when the kidney (or the part of it) draining through the ectopic ureter is not working well. It may also be used when that part of the kidney works well & the other kidney is normal. The surgeon may use laparoscopy (surgery using keyhole-sized incisions and long, chopstick-lượt thích instruments) since most of the abnormal ureter can be removed.

The main risks of this surgery are that good kidney tissue may be removed, or the blood supply may be injured. If there is no VUR inlớn the ectopic ureter, there is less risk for infection.

Ureteroureterostomy

For this surgery, the ectopic ureter is split near the bladder. It is then sewn into lớn the normal ureter of the lower kidney. This lets the urine from the upper part of the kidney drain normally. The kidney tissue is also protected.

The risk of harm to the lower ureter is very small with this surgery. There is a small risk of urine leak. If a temporary internal drainage stent (tube) is placed, more anesthetic may be used lớn remove sầu it.

Ureteral Re-implantation

For this surgery, the ectopic ureter is split near the bottom và sewn inkhổng lồ the bladder. This is done so that urine drains well and does not flow backwards. This surgery often requires a cut above sầu the pubic bone.

This method has a slightly higher chance of problems than the other surgeries. It can be difficult to persize in small infants. The surgeon needs to lớn make the ureter smaller, so there is less risk of VUR later on. This increases the risk of blockage. But like ureteroureterostomy, this operation preserves all kidney tissue.


Imaging after Treatment

A renal ultrasound is usually done 4 khổng lồ 6 weeks after surgery to lớn see if the surgery worked. If ureteral re-implantation was done, VCUG may be used lớn see if there is any reflux.

Future Kidney Problems

If part or all of a kidney is working poorly or removed, but the other kidney is normal, the child will not have lifelong kidney problems. Most often just the upper part of one kidney is affected. This means the rest of the kidney can function well. Even when a whole kidney is affected, long-term problems are not likely.

One normal kidney is all we need for good health. Children are often born with a single kidney and no one knows it. People who donate a kidney also vì chưng fine. The only issue is that you no longer have sầu a spare kidney. If your remaining kidney is seriously injured (for any reason) then you would have sầu kidney failure & require dialysis.

Sexual Function

Though an ectopic ureter can drain to the sex organs, it does not affect sexual function. This issue rarely impacts a person’s ability to lớn have a baby.

In boys, the genital tract on the same side of the ectopic ureter may be abnormal. But if the other side is not affected (which is most often the case), then fertility should still be normal.