title: Challenges in the management of bilateral single-system ectopic ureters in male infants.
abstract: OBJECTIVE
  To describe our experience of managing bilateral single-system ectopic ureters in boys.
  
  
  METHODS
  We discuss difficulties in diagnosis, importance of appropriate preoperative imaging, and the individualized surgical management for this rare congenital malformation.
  
  
  RESULTS
  The first patient aged 3 months presented with urosepsis-subsequent imaging demonstrated bilateral single-system ectopic ureters, which were reimplanted at age 7 months. The second case was an antenatal diagnosis of bilateral hydronephrosis. Postnatal imaging identified bilateral ectopic single-system ureters. A suprapubic catheter was inserted to ensure optimal bladder drainage. He underwent a Cohen reimplantation at age 7 months because of recurrent urinary tract infections. The third patient was born with a duodenal atresia (repaired in the neonatal period) and a complex anorectal malformation, including a pouch colon with a colourethral fistula, a dilated, ectopic left ureter, and a hypoplastic urethra. He was initially managed with a colostomy and suprapubic catheter. At age 14 months, he underwent a left nephrouretectomy for a nonfunctioning kidney and posterior sagittal anorectoplasty. The right ureter was noted to be ectopic at this time and was reimplanted.
  
  
  CONCLUSIONS
  Our series highlights the many challenges for diagnosis and management in boys with this condition because of the diverse presentation and need for appropriate preoperative imaging. Treatment is by bilateral ureteric reimplantation at an appropriate age.
authors.affiliation: Department of Paediatric Urology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Connor
authors.affiliation: Department of Paediatric Urology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom.
authors.forename: Riyad
authors.initials: R
authors.lastname: Peeraully
authors.affiliation: Department of Paediatric Urology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom. Electronic address: gshepherd@doctors.org.uk.
authors.forename: Gregory
authors.initials: G
authors.lastname: Shepherd
authors.affiliation: Department of Paediatric Urology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom.
authors.forename: Manoj
authors.initials: M
authors.lastname: Shenoy
mesh_terms: D002828:Choristoma / Q000175:diagnosis / Q000601:surgery*; D003558:Cystoscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D035583:Rare Diseases; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000175:diagnosis* / Q000601:surgery; D014555:Urination Disorders / Q000503:physiopathology; D014564:Urogenital Abnormalities / Q000175:diagnosis / Q000601:surgery