title: Diagnostic work-up and laparoscopic correction of an ectopic ureter.
abstract: BACKGROUND
  A duplex renal collecting system is a common congenital anomaly in children. Continuous dribbling (especially if after the toilet-training period) should raise suspicion of the presence of an ectopic ureter, which is most often associated with ureteral duplication. This video will demonstrate the complete diagnostic work-up necessary in these cases.
  
  
  METHODS
  A 10-year-old girl presented with continuous dribbling. Ultrasonography and computerized tomography depicted a duplex system on the left side, with the upper pole ureter ectopically inserting into the vaginal cavity and good upper pole renal parenchyma. A careful urethrocystoscopy showed a topic right ureteral orifice and a topic lower pole left ureteral orifice. Retrograde pyelography was performed and displayed normal left lower pole anatomy. A vaginography was performed, which showed reflux to the ectopic ureter. Vaginoscopy clearly identified the ectopic ureteral orifice. A guide wire was introduced through this meatus and retrograde contrast injection confirmed the diagnosis of an ectopic ureter.
  
  
  RESULTS
  At laparoscopy, a larger upper pole ureter and a normal lower pole ureter on the left side were identified. A termino-lateral ureteroureteral anastomosis was performed. After the procedure, the child reported immediate resolution of urinary dribbling.
  
  
  CONCLUSIONS
  In order to optimize its surgical correction, efforts should be made to appropriate localization of the ectopic ureter.
authors.affiliation: Pediatric Urology Unit, Division of Urology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil.
authors.forename: B N
authors.initials: BN
authors.lastname: Cezarino
authors.affiliation: Pediatric Urology Unit, Division of Urology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil. Electronic address: robertoiglesias@terra.com.br.
authors.forename: R I
authors.initials: RI
authors.lastname: Lopes
authors.affiliation: Pediatric Urology Unit, Division of Urology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil.
authors.forename: L M
authors.initials: LM
authors.lastname: Oliveira
authors.affiliation: Pediatric Urology Unit, Division of Urology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil.
authors.forename: F T
authors.initials: FT
authors.lastname: Dénes
authors.affiliation: Pediatric Urology Unit, Division of Urology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Srougi
mesh_terms: D002648:Child; D003558:Cystoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery; D014515:Ureteral Diseases / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D014567:Urography / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Duplication; Ectopic ureter; Laparoscopy; Urinary tract