BAU 2018

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A 53 year old woman presented with a case of continuous

incontinence since childhood. All throughout childhood until

the age of 45, the patient struggled with recurring urinary

infections aside from the continuous incontinence. During

the work up of the infections, a retrograde urography

confirmed the presence of a duplicated urinary system of

the left kidney. The patient underwent laparoscopic

resection of the upper (atrophic) kidney pole, which helped

with the infections, but didn’t alter the incontinence.

Diagnosis

Conclusions

A rare case of continuous incontinence in an adult female

D. Vucenovic –MD , D. Arnold - MD, N. Toussaint – MD, N. Geurts - MD, T. Debacker - MD

Ziekenhuisnetwerk Antwerpen - Middelheim

After years of struggling the patient decided to seek help

for the incapacitating incontinence. Since the patient had

more complaints after urinating, an MRI of the pelvis was

performed to exclude a urethral diverticulum. The MRI

didn’t show any anomalies. A cystoscopy was performed

showing a small orifice on the left side of the middle part of

the urethra.

The patient underwent a cystoscopy under general

anaesthesia. A catheter (5Ch) was introduced into the

orifice. A retrograde urethrographie confirmed a remnant of

the ectopic ureter, measuring 5cm in length and 1,5cm

diameter.

As early diagnosis and treatment can cause a decrease in

psychological and social repercussions, this case highlights

the importance of a good history taking and technical work

up in a middle aged patient with continuous incontinence

since childhood.

A transvaginal approach for the resection of the ectopic

ureter remnant, is a feasible and successful treatment

option.

Case TreatmentA resection of the remnant of the ectopic ureter was proposed to the patient using a transvaginal approach. Through a cystoscopy a catheter was introduced in the orifice of the ectopic ureter, using it as a guide throughout the procedure. In the second part of the surgery ; the vaginal wall was incised using an inversed U-incision. The ectopic ureter was located, using the catheter as a guide. The ureter was completely dissected and a ligature was made at the base of the ectopic ureter. The vaginal wall was sutured.

Hypothesis

Results

While the remnant of the ureter wasn’t connected to any

collecting system, it still gave the problem of

incontinence. The hypothesis was that while urinating the

remnant filled wilt urine through reflux, giving rise to a

continuous incontinence as the ectopic ureter emptied

afterwards.

Four weeks after the surgery the patient presents at the

consultation. The patient has been free of the continuous

incontinence ever since the surgery.