Megaureter and Other Congenital Ureteral Anomalies Clinical Presentation

Updated: Jan 17, 2020
  • Author: Christopher S Cooper, MD, FACS, FAAP; Chief Editor: Edward David Kim, MD, FACS  more...
  • Print
Presentation

History

No specific clinical signs are associated with ureteral anomalies. In most cases the anomaly is an incidental finding on a routine prenatal ultrasound, and the condition can be addressed before symptoms or infection develop. Some patients present with a urinary tract infection (UTI), abdominal mass, or hematuria. Children with primary megaureters may also present with cyclic abdominal pain/flank pain, or, less commonly, in acute pain crisis. [4]  Patients may present with a cystic mass at the urethral meatus representing a prolapsed ureterocele. In other patients, the diagnosis is incidental after imaging studies for unrelated symptomatology.

Ureteral anomalies may be discovered during the evaluation of a patient with hypertension, proteinuria, or even renal insufficiency (in rare cases of severe bilateral anomalies).

Approximately 50% of females with ectopic ureters present with constant urinary incontinence or vaginal discharge. Consideration of an ectopic ureteral insertion should be given in prepubertal boys with recurrent epididymitis. Postpubertal males with ectopic ureters most commonly present with complaints of chronic prostatitis and painful intercourse and ejaculation. In males, incontinence is never due to an ectopic ureter because the ectopic ureter never inserts distal to the external urethral sphincter.