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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

Authors
 Yong Seung Lee  ;  Young Jae Im  ;  Sang Woon Kim  ;  Myung-Joon Kim  ;  Mi-Jung Lee  ;  Neddy Lee Lim  ;  Sang Won Han 
Citation
 JOURNAL OF PEDIATRIC SURGERY, Vol.51(3) : 469-474, 2016 
Journal Title
 JOURNAL OF PEDIATRIC SURGERY 
ISSN
 0022-3468 
Issue Date
2016
MeSH
Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Kidney/abnormalities* ; Kidney/surgery ; Magnetic Resonance Imaging ; Nephrectomy* ; Radiopharmaceuticals ; Retrospective Studies ; Sensitivity and Specificity ; Technetium Tc 99m Dimercaptosuccinic Acid ; Tomography, X-Ray Computed ; Treatment Outcome ; Ureter/abnormalities* ; Urinary Incontinence/congenital ; Urinary Incontinence/etiology ; Urinary Incontinence/surgery* ; Urogenital Abnormalities/complications ; Urogenital Abnormalities/diagnosis* ; Urogenital Abnormalities/surgery
Keywords
Nephrectomy ; Tc-99m dimercaptosuccinic acid ; Ureter ; Urinary incontinence
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 59.3months. 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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0022346815005710
DOI
10.1016/j.jpedsurg.2015.09.004
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myung Joon(김명준) ORCID logo https://orcid.org/0000-0002-4608-0275
Kim, Sang Woon(김상운) ORCID logo https://orcid.org/0000-0002-5790-1948
Lee, Mi-Jung(이미정) ORCID logo https://orcid.org/0000-0003-3244-9171
Lee, Yong Seung(이용승) ORCID logo https://orcid.org/0000-0003-3778-9888
Im, Young Jae(임영재)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146504
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