New-Onset Continuous Urinary Incontinence After Ectopic Ureteral Stone Surgery with Pre-existing Stress Urinary Incontinence: A Case Report

Abstract Background: Adult ectopic ureter is uncommon and may be overlooked when a common cause of urinary incontinence coexists.

Case presentation

A 66-year-old woman had a 2-year history of intermittent urinary leakage during coughing or physical activity. She later developed right flank pain and fever. Computed tomography (CT) demonstrated bilateral duplicated collecting systems and a right upper-pole ectopic ureter opening into the urethra, with an approximately 11×8 mm calculus impacted near its distal opening (Fig. 1A, B). Ureteroscopic lithotripsy relieved the flank pain. Subsequent urodynamic evaluation demonstrated moderate stress urinary incontinence (SUI) (Fig. 1C), and a tension-free vaginal tape (TVT) procedure initially improved the leakage. One month after TVT, however, the leakage changed to continuous urine loss unrelated to coughing, activity, or body position. Repeat urodynamics were normal, and the leaking fluid remained clear during bladder methylene blue instillation. Cystoscopic reassessment and review of the known duplicated anatomy raised suspicion of an ectopic urinary source (Fig. 2A). Laparoscopy confirmed the ectopic right upper-pole ureter (Fig. 2B), which was reimplanted into the bladder. Postoperative retrograde pyelography documented the reconstructed system (Fig. 2C), and the patient no longer experienced urinary leakage.