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Duplicated and Ectopic Ureter
Bryan R. Foster, MD; Amir A. Borhani, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Duplex kidney
            • Double or bifid ureters
            • Ureteral ectopia
          • Definitions

            • Ectopic ureter: Ureteral orifice below normal insertion in trigone; usually associated with duplicated collecting system
            • Complete duplicated ureter: 2 ureters drain duplex kidney and remain separate down to bladder insertion or beyond
              • One of ureters is, by definition, ectopic
            • Incomplete duplicated ureter: 2 ureters drain duplex kidney and join to form single ureter prior to bladder insertion
              • a.k.a. bifid ureter

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Houat AP et al: Congenital anomalies of the upper urinary tract: a comprehensive review. Radiographics. 41(2):462-86, 2021
                                          2. Calle-Toro JS et al: Morphologic and functional evaluation of duplicated renal collecting systems with MR urography: a descriptive analysis. Clin Imaging. 57:69-76, 2019
                                          3. Toia B et al: Diagnosis and surgical outcomes of ectopic ureters in adults: a case series and literature review. Neurourol Urodyn. 38(6):1745-50, 2019
                                          4. Didier RA et al: The duplicated collecting system of the urinary tract: embryology, imaging appearances and clinical considerations. Pediatr Radiol. 47(11):1526-38, 2017
                                          5. Thotakura P et al: The "nubbin" sign. Abdom Radiol (NY). 41(2):340-1, 2016
                                          6. Adeb M et al: Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am. 21(4):717-30, 2013
                                          7. Braga LH et al: Ureteral duplication with lower pole ureteropelvic junction obstruction: laparoscopic pyeloureterostomy as alternative to open approach in children. Urology. 73(2):374-6; discussion 376, 2009
                                          8. Steyaert H et al: Functional ectopic ureter in case of ureteric duplication in children: initial experience with laparoscopic low transperitoneal ureteroureterostomy. J Laparoendosc Adv Surg Tech A. 19(1):S245-7, 2009
                                          9. Chen CP et al: Prenatal evaluation with magnetic resonance imaging of a giant blind ectopic ureter associated with a duplex kidney. Ultrasound Obstet Gynecol. 31(3):360-2, 2008
                                          10. Duong DT et al: A case of ectopic dysplastic kidney and ectopic ureter diagnosed by MRI. Nat Clin Pract Urol. 5(11):632-6, 2008
                                          11. Jain P et al: Uncrossed complete ureteral duplication with dysplastic lower moiety: a violation of the Weigert-Meyer law. J Pediatr Urol. 4(5):404-6, 2008
                                          12. Lipson JA et al: Subtle renal duplication as an unrecognized cause of childhood incontinence: diagnosis by magnetic resonance urography. J Pediatr Urol. 4(5):398-400, 2008
                                          13. McGee SM et al: Cystic dysplasia of testis associated with ectopic ureter causing chronic orchalgia. Urology. 73(6):1423.e7-8, 2008
                                          14. Park BS: Type IV ureteral triplication associated with ipsilateral ureterocele with ureterolithiasis and contralateral duplication with an ectopic ureteral orifice. Int J Urol. 15(11):1022, 2008
                                          15. Roy Choudhury S et al: Spectrum of ectopic ureters in children. Pediatr Surg Int. 24(7):819-23, 2008
                                          16. Selli C et al: Robot-assisted removal of a large seminal vesicle cyst with ipsilateral renal agenesis associated with an ectopic ureter and a Müllerian cyst of the vas deferens. Urology. 71(6):1226, 2008
                                          17. Brehmer B et al: Laparoscopic heminephrectomy and resection of ectopic ureter in an adult. Urol Int. 79(3):280-3, 2007
                                          18. Croitoru S et al: Duplicated ectopic ureter with vaginal insertion: 3D CT urography with i.v. and percutaneous contrast administration. AJR Am J Roentgenol. 189(5):W272-4, 2007
                                          19. Hanson GR et al: Diagnosis of ectopic ureter as a cause of urinary incontinence. J Pediatr Urol. 3(1):53-7, 2007
                                          20. Kraft KH et al: Ten-year-old girl with crossed-fused ectopic kidney and ectopic ureter to vagina. Urology. 70(6):1220-1, 2007
                                          21. Berrocal T et al: Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features. Radiographics. 22(5):1139-64, 2002
                                          22. Zissin R et al: Renal duplication with associated complications in adults: CT findings in 26 cases. Clin Radiol. 56(1):58-63, 2001
                                          23. Fernbach SK et al: Ureteral duplication and its complications. Radiographics. 17(1):109-27, 1997
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Duplex kidney
                                                    • Double or bifid ureters
                                                    • Ureteral ectopia
                                                  • Definitions

                                                    • Ectopic ureter: Ureteral orifice below normal insertion in trigone; usually associated with duplicated collecting system
                                                    • Complete duplicated ureter: 2 ureters drain duplex kidney and remain separate down to bladder insertion or beyond
                                                      • One of ureters is, by definition, ectopic
                                                    • Incomplete duplicated ureter: 2 ureters drain duplex kidney and join to form single ureter prior to bladder insertion
                                                      • a.k.a. bifid ureter

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • Ultrasonographic Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Houat AP et al: Congenital anomalies of the upper urinary tract: a comprehensive review. Radiographics. 41(2):462-86, 2021
                                                                                  2. Calle-Toro JS et al: Morphologic and functional evaluation of duplicated renal collecting systems with MR urography: a descriptive analysis. Clin Imaging. 57:69-76, 2019
                                                                                  3. Toia B et al: Diagnosis and surgical outcomes of ectopic ureters in adults: a case series and literature review. Neurourol Urodyn. 38(6):1745-50, 2019
                                                                                  4. Didier RA et al: The duplicated collecting system of the urinary tract: embryology, imaging appearances and clinical considerations. Pediatr Radiol. 47(11):1526-38, 2017
                                                                                  5. Thotakura P et al: The "nubbin" sign. Abdom Radiol (NY). 41(2):340-1, 2016
                                                                                  6. Adeb M et al: Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am. 21(4):717-30, 2013
                                                                                  7. Braga LH et al: Ureteral duplication with lower pole ureteropelvic junction obstruction: laparoscopic pyeloureterostomy as alternative to open approach in children. Urology. 73(2):374-6; discussion 376, 2009
                                                                                  8. Steyaert H et al: Functional ectopic ureter in case of ureteric duplication in children: initial experience with laparoscopic low transperitoneal ureteroureterostomy. J Laparoendosc Adv Surg Tech A. 19(1):S245-7, 2009
                                                                                  9. Chen CP et al: Prenatal evaluation with magnetic resonance imaging of a giant blind ectopic ureter associated with a duplex kidney. Ultrasound Obstet Gynecol. 31(3):360-2, 2008
                                                                                  10. Duong DT et al: A case of ectopic dysplastic kidney and ectopic ureter diagnosed by MRI. Nat Clin Pract Urol. 5(11):632-6, 2008
                                                                                  11. Jain P et al: Uncrossed complete ureteral duplication with dysplastic lower moiety: a violation of the Weigert-Meyer law. J Pediatr Urol. 4(5):404-6, 2008
                                                                                  12. Lipson JA et al: Subtle renal duplication as an unrecognized cause of childhood incontinence: diagnosis by magnetic resonance urography. J Pediatr Urol. 4(5):398-400, 2008
                                                                                  13. McGee SM et al: Cystic dysplasia of testis associated with ectopic ureter causing chronic orchalgia. Urology. 73(6):1423.e7-8, 2008
                                                                                  14. Park BS: Type IV ureteral triplication associated with ipsilateral ureterocele with ureterolithiasis and contralateral duplication with an ectopic ureteral orifice. Int J Urol. 15(11):1022, 2008
                                                                                  15. Roy Choudhury S et al: Spectrum of ectopic ureters in children. Pediatr Surg Int. 24(7):819-23, 2008
                                                                                  16. Selli C et al: Robot-assisted removal of a large seminal vesicle cyst with ipsilateral renal agenesis associated with an ectopic ureter and a Müllerian cyst of the vas deferens. Urology. 71(6):1226, 2008
                                                                                  17. Brehmer B et al: Laparoscopic heminephrectomy and resection of ectopic ureter in an adult. Urol Int. 79(3):280-3, 2007
                                                                                  18. Croitoru S et al: Duplicated ectopic ureter with vaginal insertion: 3D CT urography with i.v. and percutaneous contrast administration. AJR Am J Roentgenol. 189(5):W272-4, 2007
                                                                                  19. Hanson GR et al: Diagnosis of ectopic ureter as a cause of urinary incontinence. J Pediatr Urol. 3(1):53-7, 2007
                                                                                  20. Kraft KH et al: Ten-year-old girl with crossed-fused ectopic kidney and ectopic ureter to vagina. Urology. 70(6):1220-1, 2007
                                                                                  21. Berrocal T et al: Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features. Radiographics. 22(5):1139-64, 2002
                                                                                  22. Zissin R et al: Renal duplication with associated complications in adults: CT findings in 26 cases. Clin Radiol. 56(1):58-63, 2001
                                                                                  23. Fernbach SK et al: Ureteral duplication and its complications. Radiographics. 17(1):109-27, 1997