Strict definition: Ureter not inserting into bladder trigone

Common usage: Ureter terminating outside bladder

70-80% have complete ureteral duplication, 5-17% bilateral

Intravesicular insertion

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  Weigert-Meyer rule: Upper moiety ureter inserts inferior and medial to lower moiety ureter, upper renal moiety obstructs

  
  
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  Lower moiety tends to have vesicoureteral reflux

  
  
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  Ureterocele may be present if ectopic vesicular insertion

Orifice commonly stenotic, leading to obstruction of renal moiety

Extravesicular insertion

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  Dilated ureter extends beyond bladder

  
  
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  Males: Prostatic urethra most common insertion site

  
  
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  Females: Vestibule or urethra most commonly

Transrectal/transvaginal US may delineate site of insertion

Compare normal position of contralateral ureteral jet at interureteric bar

Bladder diverticulum, urachal cyst, or diverticulum

Hydrosalpinx

Seminal vesicle, müllerian, ejaculatory duct, utricular cysts

Failure of separation of ureteral bud from wolffian duct results in caudal ectopia

Associated anomalies

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  Hypoplasia or dysplasia of renal moiety drained by ectopic ureter

  
  
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  Urethral duplication, hypospadias, cloacal abnormalities

  
  
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  VACTERL spectrum, including imperforate anus, tracheoesophageal fistula

M:F = 1:6; predominantly duplicated systems in females (80%) vs. single systems in males

Recurrent or chronic urinary tract infections, dribbling urinary incontinence in females, chronic or recurrent epididymitis in males

Females: Continuous dribbling (50%) due to insertion below external sphincter

Females: 80% of ectopic ureters are duplicated systems

Males: Majority associated with single system ectopic ureter

Males: No incontinence due to insertion above external sphincter

Consider diagnosis in female with continuous dribbling urinary incontinence

Trace dilated ureter to its termination below bladder

Ureteral jet can be used to identify ectopic intravesicular insertion