Ectopic ureter treatment usually require surgery, and surgeons have a number of approaches from which to choose. Diagnostic tests, such as an ultrasound and/or computed tomography (CT) imaging, can help a physician determine the best approach, which varies depending on the ectopic ureter's location and the extent of its physiological impact.
Extopic Ureter Surgery
Three chief surgical approaches exist to treating an ectopic ureter: ureteral reimplantation, nephrectomy, and ureteropyelostomy. A less common approach, but one that is used in more severe cases, is a ureterostomy.
- Ureteral reimplantation is a procedure in which a surgeon removes the ectopic ureter from its incorrect position and attaches it to the correct location in the bladder wall. The approach is minimally invasive, and uses small incisions to access the kidney and bladder. The surgeon may also place a catheter from the ureter to an incision in the abdomen to allow fluid to drain until the newly attached ureterhas time to heal. The surgery takes between two and three hours. Afterward, to minimize post-surgical pain, a child may also be given an epidural or nerve block. Patients can usually go home two to four days after surgery. The most common side effects include bladder spasms, urinary incontinence, blood in the urine (hematuria), and an increased need to urinate.
- Nephrectomy procedures may be necessary in older children when an ectopic ureter has permanently damaged a kidney or when the portion of the kidney connected to the ectopic ureter is not functioning properly. In a nephrectomy, the surgeon removes part (partial) or all (radical) of the affected kidney. To do this, he uses small incisions to access the kidney and detach it from blood vessels before removing the affected portions. A child will need pain medications to control pain at the incision site, but pain intensity and recovery time and pain level depends on each patient's pain tolerance and the surgical approach used. For example, recovery after a minimally invasive nephrectomy is faster than after an open nephrectomy, which requires a larger incision. Immediately post-surgery, a surgeon will monitor the remaining kidney's function via blood tests to ensure it's filtering blood as it should. In the long-term, children may require follow-up blood testing, typically at their yearly physical. Long-term difficulties after a radical nephrectomy are unlikely.
- Ureteropyelostomy corrects a duplex ureter system, a condition in which there is more than one ureter leading away from the kidney. Most duplex systems are completely functional and benign, with both ureters connecting to the bladder. But when only one of the ureters drains correctly and the other is ectopic, a ureteropyelostomy reroutes the ectopic ureter so it drains back into the kidney's renal pelvis (where all urine collects before draining out of the organ). This surgical approach can be performed minimally invasively or using a larger, open incision. According to the American Urological Association, the procedure has a slightly increased risk of complications compared to other ectopic ureter repair surgeries.
- Cutaneous distal ureterostomy is done only in more severe instances, when an ectopic ureter has caused a very enlarged ureter or kidney. In these cases, a surgeon makes an incision to bring the ureter through the baby's skin and allows it to drain to the surface. When the child is older—usually around 18 months—the ureter can be re-implanted to drain into the bladder.
Recovery times depend upon the surgical approach used. For laporoscopic or minimally invasive surgery, children may need be hospitalized for one to two days. More invasive surgery requires anywhere from one to five days of hospital recovery.
Ectopic Ureter Surgery Side Effects
One of the most significant post-surgery risks is infection because surgical incisions provide an entry point for bacteria. Initial signs of infection should be reported immediately and include:
- Temperature higher than 101 degrees Fahrenheit
- Excessive bleeding from the incision site
- Inability to eat or drink
- Vomiting that does not subside
- Inability to urinate
Ectopic Ureter Surgery Prognosis
A post-surgical course of antibiotics minimizes infection risk. Other possible (but rare) long-term effects include scarring at the surgical site that can cause urine reflux or urinary obstruction. For the most part, however, children recover from ectopic ureter interventions with few complications.