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DIAGNOSTIC WORKUP AND LAPAROSCOPIC CORRECTION OF AN ECTOPIC
URETER
Bruno CEZARINO, Roberto LOPES, Lorena OLIVEIRA, Francisco DENES and Miguel SROUGI
University of São Paulo Medical School, Urology, São Paulo, BRAZIL
INTRODUCTION
Duplex renal collecting system is a common congenital anomaly in the pediatric population. If the child presents with
life-long incontinence, especially after toilet training, one should suspect of ectopic insertion of the lower moiety of the
duplex system. The most commons spots of these ectopic insertions are the urethra distally to the external sphincter
and vaginal cavity. Diagnostic workup should include a renal ultrasound, VUCG, and a cysto-vaginoscopy prior to the
surgical procedure in order to identify the insertion of the ectopic ureter. This video will demonstrate the complete
diagnostic workout prior to the procedure and a laparoscopic ipsilateral ureteoureterostomy.
PATIENT AND METHODS
A 10-year-old girl presented with lifelong continuous urinary incontinence. Workup revealed a duplicated collecting
system with a functional superior moiety. Ultrassound suggested an ectopic ureteral insertion at the proximal portion of
the vaginal cavity. An intraoperative vaginography and vaginoscopy detected the ureteral orifice and a successful
catheterization showing the ectopic ureter was performed. After the final diagnostic workup a laparoscopic ipsilateral
ureteroureterostomy was performed.
RESULTS
After locating the ectopic orifice, a double J stent was placed in the lower moiety ureter and an laparoscopic uretero-
ureteroanastomosis was performed. The child reported no incontinence immediately after the procedure.
CONCLUSION
This video shows the appropriate diagnostic workup and the operative technique for a laparoscopic ureteroureterostomy.
Efforts should be made to get appropriate localization of the ectopic meatus, to optimize the surgical correction of the
duplex collecting system with an ectopic ureter.