To evaluate the functional outcomes of surgery in patients with ectopic ureters diagnosed in adulthood.

Ectopic ureters are a rare diagnosis in adults, and symptoms are often non-specific.  As such, diagnosis remains a significant challenge for clinicians, requiring a combination of detailed history and clinical examination, contrast-enhanced cross sectional imaging and cystoscopy of the urinary tract.

Patients were referred over a period of 10 years. Data including surgical history, presenting symptoms, diagnostic modalities, interventions and functional outcomes were reviewed.

9 women and 1 man had a mean age of 37 years (range 20-58). All women were referred with lifelong (low volume) leakage. The single male was referred with storage LUTS. 3 of the 9 women had previous interventions for incontinence including TVT, Botox, and bulking agent and repair of urethrovaginal fistula in one patient. Two women had upper pole heminephrectomy for non-functioning moiety with the distal ureter left in situ prior to being referred.

MRI was the predominant diagnostic tool but often took senior review to confirm the diagnosis. 

Excision of the ectopic ureter was performed with bladder neck reconstruction was performed in 6 women, with concomitant rectus fascial sling in one patient. 4 of 6 (67%) women were cured of their stress incontinence with the bladder neck reconstruction alone, whilst two required further interventions. Three women had nephroureterectomy alone as primary treatment.  Two were cured of stress incontinence but one with bladder neck ureteric ectopia required a subsequent colposuspension, with success. The single male had robotic heminephrectomy and excision of seminal vesicle, but required open repair of non-healing bladder defect and currently has a suprapubic catheter in situ.

Fine slice MRI is the imaging of choice. Excision of the ureter with bladder neck reconstruction was successful in two-thirds of patients, whilst further stress urinary incontinence surgery is required in one-third patients.

Ectopic ureter is a rare diagnosis in adults but should be considered in patients who describe lifelong incontinence.