Abstract

Introduction: The diagnosis of oligoamnios or anhydramnios is usually associated with male fetuses, being the most frequent urological cause the posterior urethral valves and the ureterocele in second place.We present an exceptional case of anhydramnios in a female fetus secondary to obstruction of a bilateral ectopic ureter with severe worsening of renal function.

Material and methods: We present the case of a preterm newborn (33+6 weeks) with a prenataldiagnosis in of bilateral ureterohydronephrosis with double left system. Labor was induced at 33 weeks due to anhydramnios.Progressive clinical, analytical and radiological worsening lead to the need of cystoscopy at nine days of life. The cystoscopic study showed a right ectopic ureter that imprinted on the vagina but whose meatus was not found, a ureter of the left upper kidney leading to the urethra, and the imprint of the left lower kidney ureter in the bladder. With electrocoagulation, a bilateral transurethral neo-orifice (TUNO) is performed as a drainage method of both dilated systems.

Results: In the postoperative period diuresis improved and creatinine progressively decreased (normal range within a month of surgery), being discharged one week after surgery.Postoperative ultrasound showed a significant decrease in bilateral ureterohydronephrosis, A year later, the patient remains asymptomatic without UTI.

Conclusion: The intravesicalization of the obstructed ectopic ureters by minimally invasive approach allows the resolution of acute urinary obstruction in a case of bilateral complex uropathy. The endoscopic approach is shown as an effective possibility in the diagnostic and therapeutic management of these patients.

Keywords: Ectopic ureter;Bilateral obstruction; Endoscopic drainage;Congenital malformation;Female fetus