The vagaries of proper imaging in diagnosing single-system ectopic ureter in children with continuous incontinence and outcomes of simple nephrectomy

Yong Seung Lee, Young Jae Im, Sang Woon Kim, Myung Joon Kim, MiJung Lee, Neddy Lee Lim, Sangwon Han

Research output: Contribution to journalArticle

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Abstract

Purpose To investigate the proper diagnostic modalities and failure cases of treatment in patients with single-system ectopic ureter (SSEU) who underwent nephrectomy for incontinence. Methods SSEU combined with dysplastic kidney is a rare cause of female incontinence. We retrospectively analyzed 45 pediatric SSEU patients that underwent simple nephrectomy at our institution during 1996-2013 for incontinence. We reviewed imaging studies to detect dysplastic kidney and ectopic ureter insertion, postoperative results, and urodynamic findings for remaining incontinence after nephrectomy. Results Median operative age was 59.3 months. Both ultrasonography and magnetic resonance imaging (MRI) showed 50.0% dysplastic kidney detection rates respectively. Dimercaptosuccinic acid (DMSA) scanning and computerized tomography (CT) showed equal detection rates of 95.5%. Ectopic ureter insertion sites were determined by ultrasonography, CT, and MRI in 17.5%, 13.6%, and 33.3% of patients, respectively. Renal vascular structures were identified in 3/22 patients (13.6%) with CT. Post-nephrectomy, incontinence disappeared in 41 patients (91.1%), but remained in 4 patients (8.9%); urodynamics suggested bladder neck incompetence in these patients. Conclusions DMSA is a highly sensitive diagnostic modality for detecting dysplastic kidney in SSEU patients with more than 95% detection rates. Once detected by DMSA, additional CT or MRI studies do not provide further information about ectopic ureter insertion or renal vascular structure. Although nephrectomy is successful in nearly 90% of SSEU patients with dysplastic kidneys, postoperative incontinence occasionally remains and requires additional treatment.

Original languageEnglish
Pages (from-to)469-474
Number of pages6
JournalJournal of Pediatric Surgery
Volume51
Issue number3
DOIs
Publication statusPublished - 2016 Mar 1

Fingerprint

Ureter
Nephrectomy
Kidney
Succimer
Tomography
Urodynamics
Magnetic Resonance Imaging
Blood Vessels
Ultrasonography
Treatment Failure
Urinary Bladder
Pediatrics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{f6cafef9887047419d7a4fd510bbaf03,
title = "The vagaries of proper imaging in diagnosing single-system ectopic ureter in children with continuous incontinence and outcomes of simple nephrectomy",
abstract = "Purpose To investigate the proper diagnostic modalities and failure cases of treatment in patients with single-system ectopic ureter (SSEU) who underwent nephrectomy for incontinence. Methods SSEU combined with dysplastic kidney is a rare cause of female incontinence. We retrospectively analyzed 45 pediatric SSEU patients that underwent simple nephrectomy at our institution during 1996-2013 for incontinence. We reviewed imaging studies to detect dysplastic kidney and ectopic ureter insertion, postoperative results, and urodynamic findings for remaining incontinence after nephrectomy. Results Median operative age was 59.3 months. Both ultrasonography and magnetic resonance imaging (MRI) showed 50.0{\%} dysplastic kidney detection rates respectively. Dimercaptosuccinic acid (DMSA) scanning and computerized tomography (CT) showed equal detection rates of 95.5{\%}. Ectopic ureter insertion sites were determined by ultrasonography, CT, and MRI in 17.5{\%}, 13.6{\%}, and 33.3{\%} of patients, respectively. Renal vascular structures were identified in 3/22 patients (13.6{\%}) with CT. Post-nephrectomy, incontinence disappeared in 41 patients (91.1{\%}), but remained in 4 patients (8.9{\%}); urodynamics suggested bladder neck incompetence in these patients. Conclusions DMSA is a highly sensitive diagnostic modality for detecting dysplastic kidney in SSEU patients with more than 95{\%} detection rates. Once detected by DMSA, additional CT or MRI studies do not provide further information about ectopic ureter insertion or renal vascular structure. Although nephrectomy is successful in nearly 90{\%} of SSEU patients with dysplastic kidneys, postoperative incontinence occasionally remains and requires additional treatment.",
author = "Lee, {Yong Seung} and Im, {Young Jae} and Kim, {Sang Woon} and Kim, {Myung Joon} and MiJung Lee and Lim, {Neddy Lee} and Sangwon Han",
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The vagaries of proper imaging in diagnosing single-system ectopic ureter in children with continuous incontinence and outcomes of simple nephrectomy. / Lee, Yong Seung; Im, Young Jae; Kim, Sang Woon; Kim, Myung Joon; Lee, MiJung; Lim, Neddy Lee; Han, Sangwon.

In: Journal of Pediatric Surgery, Vol. 51, No. 3, 01.03.2016, p. 469-474.

Research output: Contribution to journalArticle

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AU - Kim, Myung Joon

AU - Lee, MiJung

AU - Lim, Neddy Lee

AU - Han, Sangwon

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N2 - Purpose To investigate the proper diagnostic modalities and failure cases of treatment in patients with single-system ectopic ureter (SSEU) who underwent nephrectomy for incontinence. Methods SSEU combined with dysplastic kidney is a rare cause of female incontinence. We retrospectively analyzed 45 pediatric SSEU patients that underwent simple nephrectomy at our institution during 1996-2013 for incontinence. We reviewed imaging studies to detect dysplastic kidney and ectopic ureter insertion, postoperative results, and urodynamic findings for remaining incontinence after nephrectomy. Results Median operative age was 59.3 months. Both ultrasonography and magnetic resonance imaging (MRI) showed 50.0% dysplastic kidney detection rates respectively. Dimercaptosuccinic acid (DMSA) scanning and computerized tomography (CT) showed equal detection rates of 95.5%. Ectopic ureter insertion sites were determined by ultrasonography, CT, and MRI in 17.5%, 13.6%, and 33.3% of patients, respectively. Renal vascular structures were identified in 3/22 patients (13.6%) with CT. Post-nephrectomy, incontinence disappeared in 41 patients (91.1%), but remained in 4 patients (8.9%); urodynamics suggested bladder neck incompetence in these patients. Conclusions DMSA is a highly sensitive diagnostic modality for detecting dysplastic kidney in SSEU patients with more than 95% detection rates. Once detected by DMSA, additional CT or MRI studies do not provide further information about ectopic ureter insertion or renal vascular structure. Although nephrectomy is successful in nearly 90% of SSEU patients with dysplastic kidneys, postoperative incontinence occasionally remains and requires additional treatment.

AB - Purpose To investigate the proper diagnostic modalities and failure cases of treatment in patients with single-system ectopic ureter (SSEU) who underwent nephrectomy for incontinence. Methods SSEU combined with dysplastic kidney is a rare cause of female incontinence. We retrospectively analyzed 45 pediatric SSEU patients that underwent simple nephrectomy at our institution during 1996-2013 for incontinence. We reviewed imaging studies to detect dysplastic kidney and ectopic ureter insertion, postoperative results, and urodynamic findings for remaining incontinence after nephrectomy. Results Median operative age was 59.3 months. Both ultrasonography and magnetic resonance imaging (MRI) showed 50.0% dysplastic kidney detection rates respectively. Dimercaptosuccinic acid (DMSA) scanning and computerized tomography (CT) showed equal detection rates of 95.5%. Ectopic ureter insertion sites were determined by ultrasonography, CT, and MRI in 17.5%, 13.6%, and 33.3% of patients, respectively. Renal vascular structures were identified in 3/22 patients (13.6%) with CT. Post-nephrectomy, incontinence disappeared in 41 patients (91.1%), but remained in 4 patients (8.9%); urodynamics suggested bladder neck incompetence in these patients. Conclusions DMSA is a highly sensitive diagnostic modality for detecting dysplastic kidney in SSEU patients with more than 95% detection rates. Once detected by DMSA, additional CT or MRI studies do not provide further information about ectopic ureter insertion or renal vascular structure. Although nephrectomy is successful in nearly 90% of SSEU patients with dysplastic kidneys, postoperative incontinence occasionally remains and requires additional treatment.

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