Ectopic ureter in girls: constant dribbling despite normal peeing

What is an ectopic ureter?

The ureter is the tube that carries urine from the kidney to the bladder. Normally it opens inside the bladder, and urine is held there by the sphincter muscle. An ectopic ureter opens somewhere other than the bladder.

In girls, an ectopic ureter often opens below the sphincter: into the urethra, next to its opening, at the entrance to the vagina or inside the vagina. Urine from that ureter is then not held back at all and dribbles out constantly.

Ectopic ureter is about 5 times more common in girls than in boys. Most often it is the ureter draining the upper part of a duplex kidney.

Symptoms

The typical picture is:

• she pees regularly and normally,
• but in between, her underwear is always a little damp, day and night,
• there are almost no dry spells,
• parents sometimes think it is heavy, watery discharge rather than urine,
• the constant dampness can make the skin around the genitals red.

This is different from ordinary daytime wetting, where a child gets wet with a sudden strong urge but stays dry in between.

In babies, an ectopic ureter is often found during pregnancy or after birth on ultrasound as a widened ureter and kidney. In some babies the first sign is a urinary tract infection with fever.

In boys, an ectopic ureter always opens above the sphincter, so it does not cause dribbling, but it can lead to infections, including repeated epididymitis.

Diagnosis

• Examination. The doctor gently looks at the external genitalia; sometimes the ectopic opening can be seen next to the urethra or the vagina.
• Ultrasound. Shows the duplex kidney, a widened upper part and the ureter.
• MRI (MR urography). Shows the parts of the kidney and the course of the ureter in detail.
• DMSA or MAG3 scan. Shows how well each part of the kidney works.
• VCUG. To check for reflux.

Treatment

Because the dribbling comes from the anatomy, bladder training will not make it go away. For girls with constant dribbling, surgery is considered. The type of operation depends on how well that part of the kidney works:

• If it works: an operation that keeps it is chosen. The ectopic ureter is either reattached to the bladder (ureteral reimplantation) or joined to the ureter or pelvis of the lower part of the kidney.
• If it hardly works and causes problems: that part of the kidney may be removed along with its ureter.

These operations can be done open, laparoscopically or with robotic assistance, with similar results.

In newborns with a widened ureter and kidney, the doctor may prescribe a daily preventive antibiotic to reduce the risk of infection.

When to see a doctor

If your toilet-trained daughter’s underwear stays damp all day, especially when she pees normally, see a pediatric urologist. If she has a fever, back or side pain, or vomiting, have her seen the same day. Related topics: duplex kidney and ureterocele.