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Ureter Defects

By

Ronald Rabinowitz

, MD, University of Rochester Medical Center;


Jimena Cubillos

, MD, University of Rochester School of Medicine and Dentistry

Last full review/revision Oct 2020| Content last modified Oct 2020
Click here for the Professional Version
Topic Resources

A Look Inside the Urinary Tract

Organs of the Urinary Tract

Complications of birth defects of the ureters

Urinary reflux usually happens when defects involve the junction where a ureter connects to the bladder. Normally the junction allows urine to flow only one way, from the kidneys to the bladder. Defects of the junction can allow urine to flow backward from the bladder into the kidney (urinary reflux). Reflux can affect one side or both sides.

Types of Birth Defects of the Ureters

Abnormalities of the ureters include

  • Extra ureters (duplication abnormalities)

  • Narrowed or widened ureters

  • Misplaced ureters

  • Bulging of the lower end of the ureter into the bladder (ureterocele)

Extra ureters

Sometimes while a fetus is forming, the ureters split or duplicate, resulting in two ureters coming from a single kidney. Usually the extra ureter enters the bladder (complete duplication), but sometimes the two ureters join together before they enter the bladder (partial duplication).

Many children who have duplicated ureters do not have symptoms. However, sometimes the connections between the duplicated ureters and the bladder are abnormal. Some abnormal connections block urine flow. Other abnormal connections allow urine to flow backward from the bladder into the kidneys (urinary reflux Urinary Reflux Urinary reflux is when urine flows backward from the bladder into the ureter and sometimes the kidney, usually because of a birth defect of the urinary tract. Each kidney continuously filters... read more ). Both types of abnormal connection increase risk of infection and kidney damage and may require surgery.

Less often, the duplicated ureter is attached to an area outside the bladder. In girls, the ureter may enter the vagina instead of the bladder, leading to constant dripping of urine from the vagina. In boys, the ureter may enter parts of the male reproductive system such as the vas deferens The male reproductive system includes the penis, scrotum, testes, epididymis, vas deferens, prostate, and seminal vesicles. The penis and the urethra are part of the urinary and reproductive... read more , seminal vesicles The male reproductive system includes the penis, scrotum, testes, epididymis, vas deferens, prostate, and seminal vesicles. The penis and the urethra are part of the urinary and reproductive... read more , or the ejaculatory ducts. Boys do not leak urine but may have recurring infections of the affected organ.

Male Reproductive Organs

Male Reproductive Organs

Narrowed or widened ureters

A narrowed ureter prevents urine from passing normally from the kidney to the bladder. Narrowing usually occurs where the ureter joins the kidney or where the ureter joins the bladder. Narrowed ureters block urine flow, which increases risk of infection, kidney stones, and kidney damage. Narrowings usually lessen as children grow.

A widened ureter can result from an abnormality of the ureter itself or from the bladder being blocked. Widened ureters can allow urine to flow backward from the bladder into the kidneys (urinary reflux), which increases risk of infection and kidney damage.

Misplaced ureters

A misplaced ureter does not properly enter the bladder, which can allow urine to flow backward from the bladder into the kidneys (urinary reflux Urinary Reflux Urinary reflux is when urine flows backward from the bladder into the ureter and sometimes the kidney, usually because of a birth defect of the urinary tract. Each kidney continuously filters... read more ), which increases risk of infection and kidney damage.

Ureteroceles

A ureterocele is a bulging of the lower end of the ureter into the bladder. They may affect how well the ureter drains. If ureteroceles block urine flow, they increase the risk of infection, kidney stones, and kidney damage.

Diagnosis of Ureter Defects

  • Prenatal ultrasonography

  • Voiding cystourethrography

After birth, if doctors suspect defects of the ureters, they do ultrasonography of the kidneys, ureters, and bladder before and after the child urinates. Then they do a test called voiding cystourethrography Cystography and cystourethrography There are a variety of tests that can be used in the evaluation of a suspected kidney or urinary tract disorder. (See also Overview of the Urinary Tract.) X-rays are usually not helpful in evaluating... read more (VCUG). For voiding cystourethrography, a catheter is passed through the urethra into the bladder, a liquid that shows up on x-rays (contrast agent Radiopaque Contrast Agents During imaging tests, contrast agents may be used to distinguish one tissue or structure from its surroundings or to provide greater detail. Contrast agents include Radiopaque contrast agents... read more ) is put through the catheter, and x-rays are taken before and after the child urinates.

Treatment of Ureter Defects

  • Sometimes preventive (prophylactic) antibiotics

  • Sometimes surgical procedures

Treatment depends on the specific birth defect and also on the severity of the complications.

Children who have few symptoms and no complications usually do not require treatment.

Children who have frequent urinary tract infections and/or signs of kidney damage typically need treatment. If symptoms are not too severe, doctors sometimes give children daily preventive antibiotics to prevent infection. Children with more severe symptoms usually need surgery to correct the problem and ensure urine drains properly.

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