Diagnostic Ultrasound - Abdomen and Pelvis

Ureteral Ectopia
Diagnoses: Urinary Tract
TERMINOLOGY
• Strict definition: Ureter that does not terminate at bladder
trigone
• Common usage: Ureter that terminates outside bladder
IMAGING
• Best diagnostic clue
○ 70-80% associated with complete ureteral duplication
○ Dilated ureter that extends beyond bladder
• Extravesicular insertion
○ Males: Prostatic urethra most common insertion site
○ Females: Vestibule or urethra most common insertion
site
• Orifice commonly stenotic, leading to obstruction of renal
moiety
TOP DIFFERENTIAL DIAGNOSES
• Bladder diverticulum
• Hydrosalpinx
KEY FACTS
PATHOLOGY
• Failure of separation of ureteral bud from wolffian duct
results in caudal ectopia
CLINICAL ISSUES
• Recurrent or chronic urinary tract infections (UTIs)
• Females: Continuous dribbling urinary incontinence (50%)
due to insertion below external sphincter
• Males: Chronic or recurrent epididymitis
○ No incontinence due to insertion above external
sphincter
• M:F = 1:6
• Females: 80% of ectopic ureters are duplicated systems
• Males: Majority associated with single system ectopic ureter
(SSEU)
DIAGNOSTIC CHECKLIST
• Consider diagnosis in female with continuous dribbling
urinary incontinence
(Left) Graphic shows a dilated
upper moiety ureter of a left
duplex kidney with
extravesicular ectopic
insertion into the prostatic
urethra. (Right) Graphic shows
intravesicular insertion of a
ureter from a duplex left
kidney with an associated
ureterocele.
(Left) Longitudinal oblique
ultrasound of the left pelvis
shows a dilated ureter .
There is mild urothelial
thickening ſt. (Right)
Longitudinal ultrasound of the
left kidney shows a fluid-filled
thin-walled structure ſt
representing the atrophic
upper pole moiety of a
duplicated system. The lower
pole moiety appears normal
st.
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