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Fig. 7.9 Ectopic ureter opening into the proximal urethra.

Fig. 7.10 Large ectopic ureter opening into the urethra; a guide wire has
been placed into the ureteral opening.

Intra-mural ectopic ureters can be treated using cystoscopic laser
ablation (McCarthy, 2006) (Figs 7.11 and 7.12). A 0.89 mm, angled,
hydrophilic tip guide wire is advanced up the ureter through the working
channel of the cystoscope, which is then removed, leaving the guide wire
in place. The cystoscope is then reintroduced and a diode laser fibre is
passed through the instrument channel. The laser is used in continuous
contact mode at 10–15 W to ablate the common wall between the urethra
and ureter as far back into the trigone as possible, using the guide wire
to protect the outer wall of the ureter and judge the path and depth of
the ureters. Great care must be taken not to resect too far or to penetrate
the bladder wall.