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How is Ectopic Ureter Treated?

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 to fix this problem are:

  • Nephrectomy
  • Ureteroureterostomy
  • Ureteral 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 to wait until a child is even older, often after the first birthday, for ureteral re-implantation.

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 into the ectopic ureter. Now there will be no more incontinence, and 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 and the other kidney is normal. The surgeon may use laparoscopy (surgery using keyhole-sized incisions and long, chopstick-like 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 into 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 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 to remove it.

Ureteral Re-implantation

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

This method has a slightly higher chance of problems than the other surgeries. It can be difficult to perform in small infants. The surgeon needs to 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.