Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

Eight-year-old female with pervasive developmental disorder. Wet every day and every night for as long as anyone can remember in spite of normal toilet training. Wears absorbent "pads" in her underpants. Thought to be wet because of her developmental disorder.

On physical examination, urine was seen dribbling out of her urethra. An IVP (Figure) showed bilateral duplex kidneys with slight dilation, but excellent function of the left upper pole. The right side was a normal duplex kidney. The diagnosis of left upper pole urethral ectopic ureter was made, with the ectopic orifice inserting below the urethral sphincter. A VCUG was normal. At cystoscopy, she was found to have one left ureteral orifice in the bladder and two orifices on the right, close to one another, near the trigone. The ectopic left upper pole ureteral orifice wa seen just inside the urethral meatus. She underwent a left upper to lower uretero-ureterostomy.