Ectopic ureter is a rare congenital anomaly. In a study of 19,046 autopsies on children, the incidence was 1 in 1900.1 Ectopic ureters occur more commonly in females and typically are associated with a duplicated collecting system.2 Ectopic ureters occurring in males are more often associated

with a single collecting system.2,6,7 In the case of an ectopic ureter and a duplicated collecting system, the upper pole ureter is more commonly ectopic and the lower pole ureter typically inserts into the trigone, or laterally and cranially to this structure. This anatomic location of the duplicated ureters is known as the Weigert-Meyer Inhibitors,research,lifescience,medical rule. Ectopic ureters can insert into a number of structures outside of the bladder. In men, nearly 50% insert into the prostatic urethra and 33% into a seminal vesicle. The prostatic utricle and the vas deferens are the least common sites of ectopia.8 In females, roughly 33% of the ectopic ureters insert into the urethra, NVP-BGJ398 another 33% insert into the vestibule, and 25% insert into the vagina. Insertion of ectopic ureters into the uterus or cervix is quite rare.8 The presentation Inhibitors,research,lifescience,medical of an ectopic ureter often depends upon the location of insertion. As prenatal ultrasound is performed on the vast majority of pregnant women, an increasing proportion of renal anomalies, including ectopic ureters, are discovered in utero and manifest with hydronephrosis

or hydroureteronephrosis. Inhibitors,research,lifescience,medical Discovery of ectopic ureters on prenatal ultrasound provides the opportunity for early intervention with preservation of renal parenchyma if possible. Early repair Inhibitors,research,lifescience,medical of selected cases decreases the rate of delayed partial or total nephrectomies.9 When the insertion site is distal to the urethral sphincter, the classic presentation of an ectopic ureter in females

is continuous dribbling of urine with an otherwise normal voiding pattern.10 In cases where the insertion is proximal to the sphincter, ectopic ureter may present with lower urinary symptoms, including urge incontinence, Inhibitors,research,lifescience,medical urinary tract infections, enuresis, failure to thrive, reflux, obstruction with hydronephrosis, and as an abdominal mass.2,11 Ectopic ureters in men almost never insert distal to the external sphincter and, as such, this anomaly almost never presents with incontinence, although a single case is reported in the literature.12 Men who have an because ectopic ureter inserting into the prostatic urethra typically present with urinary tract infections or lower urinary tract symptoms of urgency and frequency.2,6,11 Ectopic ureters inserting into a seminal vesicle, vas deferens, or epididymis may present with epididymitis, chronic prostatitis, abdominal pain, pelvic pain, discomfort during ejaculation, constipation, or a large abdominal mass secondary to obstruction and hydronephrosis.2,6,11,13–15 Infertility may also be a presenting sign in men with ectopic ureters.16,17 Prior to prenatal ultrasonography, ectopic ureters were usually discovered in early childhood.