Pediatric Radiology

Short reports

9 Springer-Verlag 1992 Pediatr Radiol (1992) 22:221-222

Congenital ectopic vas deferens with hypospadias S. Fasaneili 1, M. Graziani t , P. C a m p o b a s s o 2, and L. Standoli 3 J Department of Radiology, Bambino Ges6 Pediatric Hospital, Rome, Italy 2 Department of Pediatric Surgery, "Ospedale Regionale", Vicenza, Italy 3 Department of Plastic Surgery, Bambino Gesfi Pediatric Hospital, Rome, Italy Received: 14 October 1991; accepted: 12 January 1992

Abstract. A case of an ectopic vas deferens of an u n d e s c e n d e d testis is p r e s e n t e d which was associated with hypospadias. These abnormalities came to light because of the systematic a p p r o a c h we have a d o p t e d for the investigation of hypospadias in our hospital. H y p o s p a d i a s is said to be associated with abnormalities of b o t h the u p p e r and lower urinary tracts, in about 20-40 % of the r e p o r t e d cases [1]. These include conditions which m a y be a s y m p t o m a t i c and often of minimal significance such as malrotation of the kidney, ectopic kidney, d o u b l e collecting system, enlarged prostatic utricle, cyst of prostatic utricle and r u d i m e n t a r y vagina [2].

We have previously described [3] a systematic a p p r o a c h to the m a n a g e m e n t of hypospadias which is followed by the plastic surgeons of the pediatric Hospital B a m b i n o Ges/a. The first "imaging" step is a c o m b i n e d examination consisting of r e t r o g r a d e urethrography, r e t r o g r a d e cystography and voiding cystourethrography ( R U G + R C G + V C U G ) . A case is p r e s e n t e d of hypospadias where the radiology has revealed an associated a b n o r m a l i t y which we believe has not b e e n previously described [4].

Case report A 2-year-old boy, with proximal hypospadias, was submitted to RUG - R C G - V C U G.

In the course of both the RCG and VCUG (not in the first RUG phase) there was the filling of an elongated structure on the left side of the bladder, resembling a ureter, with an ectopic opening in the vesical neck. After ascending for about 5 cm, the structure tapered and appeared to double downward for 2-3cm before it disappeared (Fig. 1). We suspected that this was due to either incomplete reflux into an ectopic ureter of a double collecting system or the presence of an ectopic blind ureter of a supernumerary left system. An excretory urogram (E.U.) showed no abnormalities. So the bladder was refilled through a catheter. In the voiding phase the same tubular structure seen on RCG-VCUO appeared again (Fig. 2), independent of the lower tract, but not clearly separated in the higher part from the orthotopic ureter of the apparently normal left system. The possible diagnoses were proposed in decreasing levels of possibility. 9 A blind ectopic ureter. 9 Incomplete reflux into the ectopic lower of a duplicated collecting system. 9 Aninverted Yrare type ofureteral duplication. Urethral and vesical endoscopic examination revealed no abnormalities in the bladder but an ectopic opening in the left side of the bladder neck was identified and contrast medium was introduced into this. Filling of an ectopic vas deferens became evident associated with the left undescended testis (Fig. 3). The hypospadias was corrected in a one-stage procedure (Standoli technique) [5]. The abnormal deferens was not treated. The follow-up was uneventful.

Fig.1. VCUG. Reflux into an apparently dilated ureter on the left, opening at bladder neck. A caudal kinking of the structure gets lost within few centrimeters (arrows) Fig.2. E.U. During micturition reflux into the abnormal structure appears again. There is a close relationship with the left ureter Fig.3. Contrast medium is injected at endoscopy via the ectopic opening at bladder neck. The whole vas deferens and epididymis are seen to he in the abdominal cavity

Discussion A b s e n c e of filling of the ectopic vas deferens during the R U G and E . U . is p r o b a b l y due to the contraction of the

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bladder neck which relaxed during voiding procedures. The ectopic opening was far from the veru montanum. The inverted Y type of ureteral duplication is known but is extremely uncommon [6]. Little attention had been paid to the abnormal testis mobility, so that the true anatomical abnormality was not appreciated until the final examination was carried out. It seems interesting to us to describe this case as in our opinion, it shows the value of following our imaging protocol for hypospadias.

References 1. Shima H, Ikoma E Terakawa T, Satoh Y, Nagata H, Shimada K, Nagano S (1979) Developmental anomalies associated with hypospadias. J Uro1122: 619 2. Hertz M, R o z e n m a n J, Shafir R, Boichis H (1981) Hypospadias before and after repair: a radiological evaluation. A n n Radiol 24:147 3. Gugliantini R Fasanelli S, Bergami G L (1986) Radiographic approach to hypospadias. In: Standoli L (ed) Advances in hypospadias. Acta Medica Edizione e Congressi, Roma, pp 49

Literature in pediatric radiology Unilateral cerebellar atrophia presenting in the neonatal period. Value of MRI. Report of two cases. [In French.] Haddad, J. et al. (Serv. de PEd. 2, CHU de Hautepierre, F-67098 Strasbourg Cedex, France) 49:47 (1992) Neonatal cervical cord compression by staphylococcal abscess. [In French.] Desportes, V. et al. (Moriette, G., Serv. de MEd. NEonat., Gronpe hospitalier Cochin, 123, blvd. de Port-Royal, F-75674 Paris Cedex, France) 49:51 (1992) Abc~s du psoas neonatal simulant une arthrite de hanche (cas radiologique du tools). Frangois, A. et ai. (Serv. de PEd., Centre Hosp. Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, F-95107 Argenteuil Cedex, France) 49:55 (1992) Right atrial thrombosis after venous umbilical catheterization. Evolution after early surgery. [In French.] Paupe, A. et al. (Serv. de REanimation NEonatale, Centre Hosp. Intercommunal, rue du Champ-Gaillard, F-78303 Poissy Cedex, France) 49:105 (1992) Pneumoblastoma: a new case report. [In French]. Ben Becher, S. et al. (Serv. de PEd., Urgences et Consultations Externes, H6pital d'Enfants, Tunis Jebbari, 1007Tunesie) 49:109 (1992) SclErose tubdreuse de B ourneville et craniostEnose. (Cas radiologique du mois). [In french]. Kchonk, M. et al. (I'Inst. Nat. de Neurolog., Serv. de Neurorad., La Rabta, Tunis, Tunisie) 49:121 (1992) Journal of Neuroradiology (Paris) Doppler ultrasound study of the anterior cerebral artery in neonates. [In French] Sevely, A. et al.

4. Alfert HJ, Gillenwater JY (1972) Ectopic vas deferens communicating with lower ureter: embrylogical considerations. J Urol 108:172 5. Standoli L (1988) Vascularized urethroplasty flaps. Clin Plast Surg 15:355 6. Klauber GT, Reid E C (1972) Inverted Yreduplication of the ureter. J Uro1107: 362 S. Fasanelli D e p a r t m e n t of Radiology Hospital Bambino Gestt Piazza S. Onofrio, 4 1-00165 R o m e Italy

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(Serv. de Neurorad., HEpital Purpan, Place du Docteur-Baylac, F-31059 Toulouse Cedex, France) 18:340 (1991) Radiologie (Paris) Le crfine en feuille de tr6fle (Kleeblattsch~idel). Wackenheim, A. (Serv. de Rad. B, CHU, PavilIon Clovis-Vincent BP 426, F-67091 Strasbourg Cedex, France) 11:301 (1991) European JournalofNuclear Medicine (Berlin) Use of pertechnetate 99mTcfor abdominal scanning in localising an ileal duplication cyst: case report and review of the literature. Lecouffe, R et al. (Marchandise, X., Serv. Associ6 de MEd. Nucl., H6pital Huriez, Centre Hosp. Univ., 2 av. Oscar Lambret, F-59037 Lille Cedex, France) 19:65 (1992) European Journal of Pediatrics (Berlin) Thymic rebound following successful chemotherapy of B-lymphoma in an adolescent boy. Leibundgut, K. etal. (Hfimatol./Onkolog.,Univ.Kinderklinik, Inselspital, CH-3010 Bern, Switzerland) 151:95 (1992) Congenital hypopitnitarism: results of pituitary stimulation tests and of magnetic resonance imaging in a newborn girl. Van Hauthem, H. et al. (Van Vliet, G., Research Center H6pital Ste Justine, 3175, C6te Ste Catherine, MontrealH3TICs, QuEbec, Canada) 151:174 (1992)

Adult respiratory distress syndrome associated with mycoplasma pneumoniae infection. Van Bever, H.R et al. (Dept. of Paed., Univ. Hosp., Wllrijkstraat 10, B-2650 Edegem, Antwerp, Belgium) 151:227 (1992) The association ofhypopitnitarism with small pit uitary, invisiblepituitarystalk,type 1Arnold-Chiari malformation, and syringomyelia in seven patients born in breech position: a further proof of birth injury theory on the pathogenesis of "idiopathichypopituitarism".Fujita,K.etal. (Dept.of Paed., City Univ. Med. School, 1-5-7 Asashimachi, Abeno-ku, Osaka, 545, Japan) 151:266 (1992) The relationship of fluid restriction during the 1st month of life to the occurrence of severity of bronchopulmonary dysplasia in low birth weight infants: a 1-year radiological follow-up. Tammela, O. K. T. et aL (Dept. of Paed., Univ., Kajaanintie 50, SF-90220, Oulu, Finland) 151:295 (1992) Intra-uterine long bone growth in smalI-for-gestational-age infants. Palacios, J. et aI. (Rodrfguez, J. I.,Dept.ofPathol.,LaPazHosp.,Paseo Castellana261, E-28046 Madrid, Spain) 151:304 (1992) European Radiology (Berlin) Infantile hypopituitarism: etiological variabihty evidenced by MRI. Smet, M.-H. et al. (Dept. of Rad., Univ. Hosp. K.U., Herestraat 49, B-3000 Leuven, Belgium)2:57 (1992)

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Congenital ectopic vas deferens with hypospadias.

A case of an ectopic vas deferens of an undescended testis is presented which was associated with hypospadias. These abnormalities came to light becau...
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