Diagnosis and Treatment of Ectopic Ureter in a low resource setting Dr Shirley Heywood MB ChB FRCOG

 Background

 Women with obstetric fistula have been treated in Surkhet, Nepal, since 2009 through a programme run by International Nepal Fellowship (INF) in co-operation with the government health service in Surkhet. 

From 2009 to 2018 an annual “camp” was conducted for 2-3 weeks based at the Surkhet Regional hospital 

In 2018 a purpose built 17 bed fistula centre was opened at the Provincial Hospital Karnali Province.

 Outreach

INF conducts a fistula awareness outreach programme across  Nepal’s three western provinces, Lumbini, Karnali and Far West provinces. Through the outreach programme, since 2012, 15 women and young girls with urine incontinence due to ectopic ureter have been diagnosed and treated in Surkhet. 

Since 2023, 7 more patients presented with history suggesting ectopic ureter –  not confirmed by investigation.

Patient Characteristics

Age range - 5 years to 30 years  

Age 5-12 –  10 patients 

14 and 15  -  2 patients 

20-30         -   3 patients 

Home districts - 11 different districts

Method of referral 

 Radio broadcast – 3,  Referred by INF doctor -1 , Through community health volunteers or health workers after fistula awareness programmes - 11 

Presenting symptoms

Continuous urine incontinence, day and night but with regular voiding from birth. 

Diagnosis 

2012 – 2018  – Gynaecologist supported and trained by retired urologist from UK. For IVU or detailed US scan patients were referred to hospital in adjacent district 

 3 patients EUA - ureteric orifice opening  just below urethra

 2 patients IVU (from other centres but diagnosis had not been made)

2020-2021

2 patients – EUA – u.o. below urethra        

2023-2025  8 patients

5 diagnosis through CT IVU

3 diagnosis through US scan and EUA

                       

Management 

All patients were treated by division and implantation of the ectopic ureter into the bladder with submucous tunnelling and, when ureter normal calibre with spatulation. Ureteric catheters were kept for 7-10 days and Foley catheter was removed after the following day.

All but one recovered without complication and all were discharged well and continent. 

 

Conclusion  Ectopic ureter can be managed in a low risk setting and young women and girls be restored to health and happiness