Ectopic ureter presenting as a scrotal fistula associated with unilateral atrophic kidney: a rare case report

Introduction:An ectopic ureter is the one that reaches any place other than the trigone in the bladder, in the bladder neck or distal to it and is often associated with a single or duplicated collecting system, associated with renal dysplasia and obstruction. Ectopic ureter opening into the scrotal base as urocutaneous fistula is a rare finding.Case presentation:A 14 years old male child presented with intermittent serous discharge from the base of scrotum for 2 months, and unilateral scrotal swelling for 1 week. On evaluation of the condition as scrotal sinus, the X-ray fistulogram and micturating cystourethrogram suggested to be urocutaneous fistula, later confirmed with computed tomography of abdomen and pelvis to be right ectopic ureter opening into scrotum associated with hypoplastic right kidney. The patient underwent open excision of ectopic ureter with right nephrectomy. The histopathological report also confirmed our diagnosis.Discussion:An ectopic ureter, a congenital anomaly, may open anywhere from the bladder neck to the perineum and into the vagina, uterus and even the rectum; however commonly in posterior urethra, seminal vesicle, prostatic utricle, and ejaculatory duct in boys. Scrotum is an unusual site for single right ectopic ureter opening, as presented in our case. For this urocutaneous fistula associated with non-functioning atrophic right kidney, the complete removal of the right kidney and ectopic ureter was performed.Conclusion:Ectopic ureter can present rarely as scrotal fistula. Although difficult to diagnose, early suspicion of ectopic ureter in symptomatic pediatric age group with proper imaging modality can help to evaluate the disease condition, help in timely treatment and decrease the morbidity.