Ectopic Ureter

What is an ectopic ureter?

An ectopic ureter is a congenital urological anomaly where your ureter connects to the wrong place. Your ureters are narrow tubes of muscle that carry urine (pee) from your kidneys to your urinary bladder. Most people have two ureters — one ureter connects to each kidney, and each one also connects to one side of the bladder. “Congenital” means that you have the condition at birth.

Instead of your bladder, an ectopic ureter may carry pee to your:

• Urethra.
• Bladder neck (an area at the bottom of your bladder that connects to your urethra).
• Rectum.
• Seminal vesicles, vas deferens or ejaculatory ducts (sperm ducts).
• Uterus, cervix or vagina.

Ectopic ureters often appear alongside a duplex kidney — two ureters attach to the same kidney.

How common are ectopic ureters?

About 1 in 2,000 people have an ectopic ureter. However, it’s probably more common because it’s often not diagnosed or misdiagnosed. Ectopic ureters share many of the same symptoms as other conditions, including urinary tract infections (UTIs).

Healthcare providers diagnose most cases in children between the ages of 1 and 13. Adults are rarely diagnosed with ectopic ureters.

What are the clinical signs of an ectopic ureter?

Common ectopic ureter signs and symptoms include:

• Recurring (returning) UTIs, including pain or burning when you pee (dysuria).
• Leaking pee (urinary incontinence).
• Swollen kidney, usually because your kidneys can’t empty (hydronephrosis).
• Pee goes back up into your ureters or kidneys from your bladder (vesicoureteral reflux).

Is an ectopic ureter painful?

An ectopic ureter itself isn’t painful. But it may cause other conditions that have painful symptoms, including:

• Epididymitis.
• Inflammation in your seminal vesicles (vesiculitis).
• Prostatitis.
• UTIs.
• Pain while ejaculating (dysorgasmia or orgasmalgia).

Does an ectopic ureter affect my ability to have sex?

An ectopic ureter may cause pee to drain to your sex organs. But it rarely affects your sexual response cycle or your ability to have a biological child (fertility).

What causes an ectopic ureter?

Healthcare providers aren’t sure why ureters sometimes form differently during fetal development.

Who do ectopic ureters affect?

Anyone can have an ectopic ureter at birth. But you may have a greater chance of having an ectopic ureter if you:

• Are assigned female at birth (AFAB). For unknown reasons, people AFAB are about 10 times more likely to have an ectopic ureter.
• Have a biological family history of ectopic ureters. You have an increased risk of having an ectopic ureter if one of your biological parents has one.

How is an ectopic ureter diagnosed?

Ectopic ureters can be challenging to diagnose because they share many of the same signs and symptoms as other conditions. Healthcare providers can sometimes diagnose an ectopic ureter during a prenatal ultrasound. But if they don’t, they’ll:

• Review your health history.
• Ask about your symptoms.
• Ask if any of your biological family members have ever had an ectopic ureter.
• Conduct a physical exam.
• Order a blood test to determine your kidney health.
• Order a urine test (urinalysis) to check for infection.

To help officially diagnose an ectopic ureter, they may also order additional tests.

What tests will be done to diagnose an ectopic ureter?

A healthcare provider may order the following tests to help diagnose an ectopic ureter:

• Imaging tests. They may use a computed tomography (CT) scan, magnetic resonance imaging (MRI) or ultrasound to get detailed images of your urinary system.
• Cystoscopy. A provider uses a thin tube with a light and a camera at the end to look inside your urethra and bladder.
• Renal flow scan. This scan shows how well your kidneys work and checks for irregularities. A provider injects a small amount of radioactive dye into your body and uses a gamma camera to examine how the dye flows through your urinary system.
• CT urogram. A CT urogram also uses a dye to examine your urinary system. A provider then uses X-rays, CT scans or an MRI to take images of your kidneys, bladder and ureters as the contrast dye moves through them.
• Voiding cystourethrogram (VCUG). A VCUG also uses a dye and an X-ray to show how fluid moves through your urinary system.

Can an ectopic ureter be fixed?

Yes, healthcare providers can surgically treat an ectopic ureter.

How is an ectopic ureter treated?

Surgery is the only way to treat an ectopic ureter. The goal is to correct the problem and drain pee away from your kidney to prevent damage.

A healthcare provider may perform one of the following surgeries to treat an ectopic ureter:

• Ureteroureterostomy. This surgery treats an ectopic ureter and duplex kidney by creating a Y-like connection between the ectopic ureter and a normal one.
• Ureteral reimplantation. This surgery attaches the ureter to the correct position in your bladder wall.
• Ureterostomy. A surgeon creates an opening (stoma) on the surface of the skin on your abdomen. Pee passes through your kidneys and exits your body through your stoma, where it collects in a bag or diaper.
• Nephrectomy. A surgeon will remove part of your kidney (partial nephrectomy) or your entire kidney (radical nephrectomy). Providers only use a nephrectomy as a last option when your kidney function is low and your other kidney is healthy.

What is the success rate of ectopic ureter surgery?

It depends on the type of surgery that a healthcare provider will use to correct your ectopic ureter. But in general, each type of surgery has a high success rate. Talk to a provider to learn more about their recommended treatment, including any possible complications.

What happens if an ectopic ureter is left untreated?

An untreated ectopic ureter increases your risk of developing UTIs and kidney damage.

In people AFAB, an ectopic ureter can insert beyond the urinary sphincter muscle and cause urinary incontinence.

What is the recovery time for ectopic ureter surgery?

It depends on what type of surgery you have and your or your child’s age. Infants and young children usually need to stay in the hospital for at least a few days after surgery so that healthcare providers can keep a close eye on them as they heal.

Most people start to feel better a few weeks after a ureteroureterostomy, ureteral reimplantation or ureterostomy. But it may take up to a few months to feel better after a radical nephrectomy. A healthcare provider will give you a better idea of your recovery timeline according to their recommended treatment.

Can an ectopic ureter be prevented?

No, there’s no way to prevent an ectopic ureter. There’s also nothing you did during your pregnancy to cause your child to develop an ectopic ureter. It’s an irregularity that happens sometimes, and healthcare providers aren’t sure why.

But if you have an ectopic ureter or received treatment for an ectopic ureter when you were younger, it’s a good idea to mention that to your children’s healthcare providers. Ectopic ureters can run in families. Your obstetrician or your child’s pediatrician may recommend tests to diagnose an ectopic ureter early.

What can I expect if I have an ectopic ureter?

With proper treatment, the outlook for people who have an ectopic ureter is good. Even if a healthcare provider removes part or all of your kidney, your remaining kidney will get bigger and stronger. You shouldn’t notice much of a difference after you recover. But your provider will recommend that you schedule follow-up appointments with a kidney specialist (nephrologist) to make sure your kidney is functioning well.

An ectopic ureter also rarely affects sexual function or your ability to have biological children.

When should I see a healthcare provider?

Schedule an appointment with a healthcare provider if you or your child has any symptoms of an ectopic ureter.

What questions should I ask a healthcare provider?

Questions you may want to ask your provider include:

• Where’s the ectopic ureter, and where does it connect?
• Where’s my pee draining?
• Are there any other abnormal structures, like a duplex kidney?
• Should I consider surgery?
• What type of surgery do you recommend?
• What’s the recovery like after your recommended surgery?
• What will my kidney function be like after surgery?
• Will this affect my sexual function or ability to have biological children?

A note from Cleveland Clinic

Hearing that your child has a congenital condition is one of the greatest fears of any parent. Many experience a flood of emotions and question themselves and their abilities or competencies — Why me? What did I do wrong? Could I have done more?

If your child has an ectopic ureter, it’s important to remember that you’re not to blame. Healthcare providers aren’t sure what causes it — they appear to happen without any specific cause. And it can be hard to diagnose because it shares many of the same symptoms as other conditions. A provider may detect it before birth, soon after birth or any time during childhood or adulthood. However, once a provider diagnoses an ectopic ureter, the outlook is good. The different surgical treatments all have a high success rate, and many people experience few or no changes in their day-to-day lives.

If you have any questions, reach out to a provider. They’re available to answer your questions and review your treatment options.