9.3.2 Ectopic ureter

Most of the ectopic megaureters are diagnosed primarily by ultrasound. In some cases, clinical symptoms can lead to diagnosis:

1. In neonates: pyuria and acute pyelonephritis.

2. In older girls: dribbling incontinence with concurrent normal micturition is characteristic. In such cases, the ectopic orifice may be found in the meatal region. Significant fluor vaginalis may be the equivalent of incontinence in little girls.

3. In pre-adolescent males: epididymitis is the usual clinical presentation and a palpable seminal vesicle may be found on digital rectal examination.

Ultrasonography, excretory urography, nuclear studies, VCUG and cystoscopy are the diagnostic tools to assess the function, to detect reflux and to rule out ipsilateral compression of the lower pole and urethral obstruction. In the clarification of incontinence in girls, a methylene blue filling of the bladder can be helpful: in case of loss of uncoloured urine, an ectopic ureter must be present. It is rarely necessary to perform a CT scan to find a small upper pole moiety invisible on IVU or by sonography.