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Congenital Ureter Anomalies

Overview :

The urogenital system, for some reason, is more likely than any other to have birth defects, and they can occur in endless variety. Ureters can be duplicated completely or partially, they can be in the wrong place, they can be deformed, and they can end in the wrong place. The trouble these abnormalities bring is directly related to their effect on the flow of urine. As long as urine flows normally through them, and only in one direction, no harm is done.

  • Duplication of ureters is quite common, either in part or completely. Kidneys are sometimes duplicated as well. Someone may have four kidneys and four ureters or two kidneys, half of each drained by aseparate ureter, or a single kidney with two, three, or four ureters attached. As long as urine can flow easily in the correct direction, such malformations may never be detected. If, however, one of the ureters has a dead end, a stricture or stenosis (narrowing), or a leaky ureterovesical valve (valve between the ureter and bladder), infection is the likely result.
  • Stricture or stenosis of a ureter prevents urine from flowing freely. Whenever flow is obstructed in the body-urine, bile, mucus, or any other liquid-infection follows. Ureters can be obstructed anywhere along their course, though the ureterovesical valve is the most common place.
  • A ureter may have an ectopic (out of place) orifice (opening)-it may enter the bladder, or even another structure, where it does not belong and therefore without an adequate valve to control reflux.
  • The primary ureter, or a duplicate, may not even reach the bladder, but rather terminate in a dead end. Urine will stagnate there and eventually cause infection.
  • A ureter can be perfectly normal but in the wrong place, such as behind the vena cava (the large vein in the middle of the abdomen). A so-called retrocaval ureter may be pinched by the vena cava so that flow is hindered. Other aberrant locations may also lead to compression and impaired flow.

Besides infection, urine that backs up will cause the ureter and the kidney to dilate. Eventually, the kidney will stop functioning because of the back pressure. This condition is called hydronephrosis-a kidney swollen with urine.

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