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Bu olgu sunumunun amacı idrar kaçırma şikayeti ile başvuran kız çocuklarında ayrıntılı anamnez ile ektopik üreter tanısı konması ve minimal invaziv yöntemle tedavi edilerek şifa sağlanması konusunda bilgi vermektir.11 yaşında kız hasta, tuvalet eğitiminin tamamlanmasından beri olan, idrar kaçırma şikayetiyle başvurdu. Hasta daha önce farklı merkezlerde birçok defa muayene edilmiş ve işeme disfonksiyonu tanısıyla tedavi edilmiş. Fakat tedaviden fayda görmemişti. Anamnezinde sürekli idrarı kaçırması mevcuttu. Urgency bulgusu yoktu. Fizik muayenede herhangi bir orta hat defekti saptanmadı. Yapılan üroflowmetri testinde patolojik bulgu yoktu. Hastanın üriner sistem ultrasonografi tetkikinde patolojik bulgu yoktu. Bu bulgular ışığında ektopik üreter olasılığı düşünülerek Manyetik Rezonans (MR) Ürografi istendi. MR Ürografi tetkikinde; sol böbrek üst polünün displastik görünümde olduğu, üst polü drene eden üreterin geniş olduğu ve sol üreterin vajina üst-arka duvarına ektopik olarak açıldığı görüldü. Statik Böbrek Sintigrafisi (DMSA) tetkikinde; sol böbrek üst poldeki displastik alanın nonfonksiyone olduğu görüldü. Bu bulgular sonucunda hastaya laparoskopik parsiyel nefrektomi + üreterektomi yapıldı. Ameliyat süresi 120 dakika, tahmini kan kan kaybı 40 ml olarak tespit edildi. Hastanın postoperatif birinci gününde sondası, ikinci gününde dreni çekilerek hasta şifa ile taburcu edildi. Ameliyat spesmeninin patoloji sonucu displastik böbrek ile uyumlu idi. Postoperatif 15. gün, 1. ve 3 aydaki kontrol muayenelerinde, hastanın inkontinans şikayetlerinin tamamen geçtiği görüldü. Sonuç olarak idrar kaçırma şikayeti ile başvuran hastalarda tedaviye yanıt yoksa, ayırıcı tanıda ektopik üreter mutlaka düşünülmelidir. Tedavisinde başarı oranı yüksek ve minimal invaziv bir yöntem olan laparoskopi tercih edilmelidir.
The purpose of this fact presentation is to provide information on the diagnosis of the ectopic producer with a detailed history in the girls who apply with a urinary loss complaint and to provide healing with minimal invasive methods.The 11-year-old girl patient has been requested with a urinary loss complaint, which has been since the completion of the toilet training. The patient has previously been examined several times in different centers and has been treated with a diagnosis of digestive dysfunction. He did not benefit from the treatment. It was constantly lost in anamnese. There was no emergency. No physical error was found in the physical examination. There were no pathological findings in the Uroflowmetry test. The patient had no pathological findings in the ultrasound examination of the urinary system. In light of these findings, magnetic resonance (MR) ultrasound was requested, considering the possibility of ectopic producer. In the ultrasound examination, the left kidney's upper polus appears displastic, the upper polus drenating producer is wide, and the left producer is ectopically opened to the upper-back wall of the vagina. Statistical kidney syntigraphy (DMSA) examination found that the displastic area in the upper pol of the left kidney was nonfonctional. As a result of these findings, the patient was given laparoscopic partial nefrectomy + euterectomy. The duration of the surgery was 120 minutes, the estimated blood loss was 40 ml. The patient's first postoperative day was removed and the patient was removed with healing on the second day. The result of the pathology of the spesmen surgery was compatible with the dysplastic kidney. Postoperative 15th day, 1. And in the 3 months of control examinations, the patient’s incontinence complaints were fully passed. As a result, if there is no response to the treatment in patients who apply with a complaint of urinary loss, the distinctive diagnosis should necessarily be considered to produce ectopic. A laparoscopy, which is a high and minimal invasive method of success in treatment, should be preferred.
The aim of this case report is to share a pediatric case with ectopic ureter opening into the vagina, which is a rare cause of medical treatment resisted female urinary incontinence and its minimally invasive treatment method. An 11-year-old girl presented with true urinary incontinence since her toilet training was completed. The patient had been treated medically many times in different centers before, but didn’t benefit from the treatment. There was no pathological finding in physical examination, uroflowmetry and ultrasonography. MRI urography was planned in the differential diagnosis considering the ectopic ureter opening into the genital system. It was observed that the upper pole of the left kidney was dysplastic and the ureter draining the upper pole was opened ectopically to the upper-posterior wall of the vagina. In Static Kidney Scintigraphy (DMSA) examination; it was observed that the dysplastic area in the left kidney was nonfunctional. As a result of these findings, laparoscopic partial upper pole nephrectomy + ureterectomy was performed. The foley catheter was removed on the first postoperative day and the drainage catheter was removed on the second day. The patient was discharged on the second postoperative day. In the postoperative 15th day, 1st and 3rd month follow-up examinations, it was observed that the patient's incontinence completely disappeared. In conclusion, Ectopic ureter should be kept in mind as differential diagnosis in cases of urinary incontinence resistant to medical treatment and Laparoscopic partial nephrectomy should be preferred for treatment as a minimally invasive method with a high success rate.
Alan : Sağlık Bilimleri
Dergi Türü : Ulusal
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