A Case Report of Ureteral Duplication

Among all congenital abnormalities, anomalies of urinary tract represent about one quarter in which the incidence of double ureter is rather common (about 1 in 125 or 0.8%), whereas a bilateral duplex collecting system is an unusual abnormality. We present a case of a patient with a combination of ureteral duplicity and ureteral bifidity.

Malformations of the urinary system are common and are found in about 3 percent of live births. These various malformations include malrotation, ectopia and other morphological variations such as number of ureters, kidneys. Duplex ureter is one of those malformations, which occurs 1 in 125 cases or 0.8% of a non-selected population with female to male ratio of 1.6:1 or 62% of females. A duplex ureter may be unilateral or bilateral and it also may be complete or incomplete. The duplication of the ureter is the most common anomaly; however bilateral total duplication is unsual. Patients with this anomaly have an increased risk of hydronephrosis, stone formation, and urinary tract infections. Therefore, considering a rare occurrence of duplication, its embryological significance and clinical implications, we report a case of ureteral duplicity and ureteral bifidity.

A 38-year-old married arab woman has been admitted to our urology department. She has been hospitalized to explore her right low back pain. A physical examination was normal. Her temperature was 37.3?°C, with a pulse rate at 76 beats per minute and her blood pressure was 130/70?mmHg. Laboratory tests were normal; in particular, a urine examination showed no bacteriuria or leukocyturia. She underwent an abdominal ultrasound which showed an asymmetric size of the kidneys with a cute right hydronephrosis. An abdominal and pelvic computed tomography (CT) scan detected a left completely duplicated collecting system with no hydroureteronephrosis. On the right, an uncomplet duplicated ureter before joining the bladder with hydroureteronephrosis. The patient was put on medical treatment controlled six months later with an abdominal ultrasound and did not have any medical intervention.

In this case, we present a bilateral duplex collecting system. The limitation of our approach was the duration of the follow-up which is only lasted approximately six months. The discussion will point out the originality of the abnormality. Bilateral duplex collecting system is an uncommon abnormality. It occurs in 1 in 500 persons and is found in 0.3% of excretory urograms [1]. Some cases have been reported on bilateral duplex collecting system [2-3]. But there are not much data about it. Generally, the cases reported in the literature are mostly related to unilateral duplex collecting system. According to the Weigert–Meyer law, the upper pole ureter typically opens medially while the lower pole ureter opens laterally. Complete ureteral duplication may be associated with other congenital anomalies such as an upper moiety ureter with an ureterocele causing obstruction or a short lower moiety intramural ureter causing VUR [4]. VUR almost always occurs into the lower pole moiety due to its lateral displacement within the bladder [5]. However, the association of bilateral duplex collecting system, bilateral VUR, and refluxing upper pole moiety is not clearly described in the literature to the best of our knowledge.

Based on the available literature, the present case is very rare. Usually it will be detected at autopsy or as radiological finding but is associated with wide variety of clinical manifestations. Hence the knowledge of which should be borne in mind when dealing with a case of repeated urinary infections, urinary reflux disorders, hydronephrosis or stone formation.

Ethics approval and consent to participate

Consent for publication: The patient included in this study gave a verbal consent to participate in this research, and to publish the data contained within this study.

Availability of data and material: Not applicable

Competing interests: The authors report no competing personal or financial interests.

Funding: This study had no funding from any resource.

All the authors contributed to the realization of this work by the study of the medical files, and ensuring the interventions, the discussions of the care as well as the reading of the work after its writing.

Acknowledgment: Not applicable

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