Urinary system in our body; consists of the kidneys, ureters, bladder, and urethra. Each kidney joins the bladder with its own ureter. The kidneys filter the substances and water to be excreted from the blood and form the urine. The formed urine is conveyed to the bladder through a thin tube system called the ureter. Urine accumulated in the bladder is excreted through the urethra.
What is the incidence?
Two ureters emerge from one kidney in approximately one in 125 people. While one of these ureters receives the urine produced in the upper half of the kidney, the other carries the urine produced in the lower part to the bladder.
In general, if both ureters open normally to the bladder, they do not cause any problems. Sometimes, the upper system ureter can open to the urethra in boys and to the vagina or urethra in girls. This pathology is called ectopic ureter. In this case, too, this ureter is quite wide. Sometimes, after the ureter, which drains the lower system, enters the bladder, they open up by forming a very short tunnel, and this causes reflux to occur in that ureter and part of the kidney.
Sometimes, they create a pathology called ureterocele by forming bubbles in the ureteral bladder that drains the upper system. Often this bubble creates a blockage at the end of the ureter. This causes enlargement of the ureter.
The incidence of ureterocele is one in 500 people. It is seen 5-6 times more often in girls. There is a 10% chance of it being bilateral. If a person has a ureterocele, 80% also has a double system ureter.
What are the symptoms?
If the ureter is enlarged or the ureterocele is large enough, it is suspected by ultrasound while the baby is in the womb. However, whether it is a refluxing dual system or an obstructing ureterocele, they usually apply to the hospital for urinary tract infection in the first month of life. Symptoms of infection may include flank pain, fever, and bloody urine.
If the upper system ureter opens to another place, not the bladder in girls, it causes constant urinary incontinence.
Required for diagnosis?
Ultrasound is initially requested for both the dual system and the ureterocele. A detailed and experienced ultrasound gives us detailed information. It gives us details of whether there is a double system, whether there is a ureterocele, ureter diameters, etc. Afterwards, DMSA (scintigraphy) for loss of kidney function and VCUG (voiding cystography) are requested to understand whether there is reflux. Sometimes, cystoscopy (thin light tube) may be required for a definitive diagnosis.
Treatment
The mode of treatment is based on the age of the patient at the time of diagnosis and the function of the affected part of the kidney and the presence of vesicoureteral reflux. In some cases, more than one action is required. In rare cases, observation (without treatment) may be recommended.
If there is a double system and the bladder is opened in both ureters and there is reflux to the ureter coming from the lower part of the kidney, this leakage is tried to be prevented either by cystoscopic subureteric injection or by open surgery.
If there is a double system ureter and the upper system ureter opens to a place other than the bladder and the upper kidney it drains is working, it is necessary to take this ureter into the bladder. If the upper part of the kidney is not functioning, this part of the kidney and the ureter should be removed.
If there is a ureterocele and it is diagnosed in the early period, it should be entered with a cystoscope, an entrance should be opened in this bubble and the urine should be drained. The next procedures vary depending on whether there is reflux, whether the ureterocele is obstructed at the bladder entrance, and whether the kidney/upper kidney is functioning. Often one or more surgeries may be required.