|Patient: 3 year old female|
|History: 3 year old female: known duplex left renal collecting system by ultrasound. She presents with persistent incontinence. By ultrasound, it was difficult to determine the site of insertion of the left upper pole moiety ureter.|
Ultrasound examination demonstrates no collecting system dilatation on the right but moderate dilatation of the left upper pole moiety collecting system all the way to the urinary bladder. There is mild prominence of the left lower pole moiety pelvis.
MR urography demonstrates no collecting system dilatation on the right but a bifid pelvis present. On the left, the upper pole moiety demonstrates sereve dilatation of the pelvis and calyces and severe dilatation and toruosity of the ureter. This dilated ureter creates mild, incomplete obstruction of the left lower pole moiety pelvis at the UPJ as well as of the distal ureter due to its mass effect.
The insertion of this left upper pole moiety ureter is ectopic, into the distal urethra.
Despite the ectopic location of the ureter, the left upper pole parenchyma appears nondysplastic and quite healthy.
|Diagnosis: Duplex left renal collecting system with ectopic insertion of the upper pole moiety ureter into the distal urethra.|
Persistent incontinence in female children raises the question of a duplex system with an ectopic ureter. Often the more ectopic the insertion, the more dysplastic the upper pole moiety.
The Weigert-Meyer rule states that, in a duplex system, the upper pole ureter is prone to obstruction and hydronephrosis while the lower pole ureter is prone to vesicoureteral reflux and pyelonephritis. The uper pole ureter inserts more medially and more inferiorly if it inserts into the bladder, but it may insert into the vagina or into the urethra. Males are not prone to incontinence as they have an external urethral sphincter. The upper pole ureter may be associated with a ureterocele.
chorus.rad.mcw.edu Weigert Meyer
C.E.Kahn, Jr. 2002
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Case Number: 31226666Last Updated: 09-20-2009 The reader is fully responsible for confirming the accuracy of this content.
The reader is fully responsible for confirming the accuracy of this content.