Isolated bilateral simplex ureteric ectopia: Bladder capacity as an indicator of continence outcome

Preoperative bladder capacity appears to be an indicator of inherent BN function and a thorough assessment of the urinary tract by cystoscopy, ultrasound, micturating cystourethrogram, and functional imaging may guide the surgeon on the need for BN surgery at the time of ureteric reimplantation. Where continence remains elusive, patients should be counselled that a further BN injection is occasionally of value although more significant BN procedures are required for most.Table. Continence outcomes for individual patients at their last FU. Cystoscopic observations regarding bladder size/BN competence and observed bladder volumes prior to cross-trigonal ureteric reimplantation with or without BN tightening.Continence outcomePatientAge at FUPre-ureteric reimplantation cystoscopic finding bladder filling on USPostoperative bladder function assessmentAfter ureteric reimplantation aloneContinent14 yNot recorded21 ml at 7 mo (36% EBCA)100 ml at 4 y (67% EBCA)26 yGood capacity14 ml at 3 mo (30% EBCA)281 ml at 6 y (130% EBCA)411 yNot recorded71 ml at 2.5 y (68% EBCA)450 ml at 11 y (125% EBCA)Enuretic58 yBN apposition230 ml at 5 y (125% EBCA)Capacity maintainedProceeding to BNC cystoplasty820 ySmall capacityBN wide openNot recorded220 ml at 14 y (50% EBCA) after colposuspensionReimplantation with BN tighteningIn nappies34 yModerate sizeBN wide open14 ml at 12 mo (20% EBCA)47 ml at 2.5 y (50% EBCA)Proceeding to BNI620 yModerate sizeBN wide openNot recordedUrodynamics: at 8 y 100% EBCA and at 20 y stress leakProceeding to AUS716 ySmall capacityEmpty on serial US at 5 y188 ml at 12 y (50% EBCA) after BNIThe EBCA is calculated for children aged below 2 years (38 ml + 2.5 ml × age in months) and those above 2 years (30 ml + 30 ml × age in years). Bladder filling is expressed as a percentage of EBCA (measured volume/EBCA × 100). AUS = artificial urinary sphincter; BN = bladder neck; BNC = bladder neck closure; BNI = bladder neck injection; EBCA = expected bladder capacity for age; FU = follow-up; mo = months; US = ultrasound; y = years.