ziekenhuisnetwerkantwerpen- middelheim · orifice. a retrograde urethrographie confirmed a remnant...
TRANSCRIPT
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.