An ectopic ureterocele, an urethrostenosis and a hypoplastic kidney in a girl with urinary tract infection and enuresis

Abstract

 Both urinary tract infection (UTI) and enuresis (nocturnal enuresis and urinary incontinence) are common issue on children and often caused by urogenital anomalies, so that we should carefully make a differential diagnosis and evaluation. We here present a case of a girl suffered from multiple UTI and enuresis with a left ectopic ureterocele, an urethrostenosis and a small left kidney.
 A 9-year-old girl was admitted to the emergency department for fever of 40.2°C with frequent urination, sense of residual urine and abdominal pain. Urinalysis exhibited an elevated count of white blood cells. She was administered on antibiotics for pyelonephritis and her complaints and the pyuria were resolved. She also troubled with enuresis totalis. We found that she had a left ureterocele and that her left kidney was small and hypoplastic. No vesicoureteral reflux was observed, but there was residual urine and she had a weak sense of urination compared to the intrabladder pressure.
 With a diagnosis of unstable bladder, distigmine bromide and prazosin hydrochloride were started, and the diurnal urinary incontinence disappeared. Because a breakthrough infection occurred, we started to give her prophylactic dose of cefaclor. Since then she had no UTI. A year later the nocturnal enuresis continued. An urethrostenosis was found with cystoscopy and an urethrotomy was performed. The left ureterocele was found to open ectopically at the neck of bladder. She does not receive medication any more for more than a year after the urethrotomy and she is free from nocturnal enuresis and UTI.
 If there is a therapy-resistant enuresis with a urogenital anomaly (anomalies), it should be recommended to administer cystography or other procedure available to reevaluate the status of the present anomaly (anomalies) and to make clear whether there would be other anomalies.