Extravesical ureteral ectopia from an iliac dystopic hypoplastic left kidney in a girl

Extravesical ureteral ectopia (EUE) is a rare cause of urinary incontinence (UI) in girls. In 80% of cases, ectopia is associated with ureteral duplication.  We are reporting a case of a 17-year-old girl with UI by EUE from an iliac dystopic hypoplastic left kidney. The girl received outpatient treatment for UI and left kidney agenesia since the age of 5, when her parents for the first time noticed the UI with background normal urination. The child underwent a complete range of medical tests: CT, cystoscopy, renal nuclear scan, uroflowmetry, ureteral cystometry and profilometry. Although the examination revealed no proof of renal tissue existence on the left side, a pad test with a dye was performed to exclude an EUE. The test gave a positive result, which determined further diagnostic search. Vascular CT was performed and made it possible to visualize a severely hypoplastic left kidney dystopic towards the iliac vessels. Laparoscopic nephrectomy was performed and UI manifestations were corrected. Availability of a wide range of visualisation methods in the urologist's toolkit does not always allow to verify hypoplastic renal dystopia when the kidney is drained by a ureter with an extravesical ectopic orifice. When a reasonable suspicion of an EUE is combined with lack of information about its location and dimensions after visualizing tests, a pad test with a dye appears appropriate prior to a diagnostic laparoscopy in our opinion. Once the UU is confirmed by the dye test results, further diagnostic search using laparoscopic access is justified and can be transformed into a treatment procedure if the kidney is revealed.

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