V1-12: Surgical Management of Mixed Urinary Incontinence From Remnant Ectopic Ureteral Stumps
VideoIntroductions and Objectives
Ectopic ureteral drainage distal to the bladder neck is a well-established cause of urinary incontinence. Mixed incontinence that persists after bilateral reimplantation, however, may be due to drainage from the remaining ureteral stumps stimulating a urethrovesical reflex.
A 24-year-old female with mixed urinary incontinence and recurrent urinary tract infections was found to have bilateral ectopic ureters inserting into the mid-urethra. Her incontinence persisted after injection of macroplastique urethral bulking agent and bilateral ureteral reimplantation. Voiding cystometrogram and Fluoro-urodynamics confirmed urine reflux into the distal ureteral stumps and subsequent spontaneous drainage, which was responsible for her incontinence symptoms. We sought to treat her incontinence with excision of the ectopic ureter stumps, bladder neck reconstruction and placement of an autologous rectus fascia urethral sling.
Transvaginal exposure of the urethra was achieved. Cystoscopically, 5-French ureteral catheters were placed directly into the ectopic ureteral stumps. The stumps were then visualized and excised and the remaining defects in the urethra and bladder neck were closed primarily. An autologous rectus fascia pubovaginal sling was harvested and secured. Postoperatively, the patient had a global assessment of improvement of 80% and regained continence.
Residual ectopic ureteral stumps after implantation can be a rare cause of persistent urinary incontinence. Successful treatment can be achieved with excision of the residual ureteral stumps, reconstruction of the bladder neck and placement of an autologous rectus fascia urethral sling.