Journal of surgical procedures and techniques
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Complete Ureteral Duplication with Ureterocele Formation in An Adult Women

Received Date:June 02, 2017Accepted Date:June 22, 2017 Published Date: June 24, 2017

Citation:Selahattin Çalışkan, et al. (2017) Complete Ureteral Duplication with Ureterocele Formation in An Adult Women. J Surg Proced Tech1: 1-3.

Abstract

Duplication of renal collecting system is a rare anomaly of urinary tract with an incidence of 0.5-3%. Complete duplex ureters that open into the urinary bladder seperately is extremely rare. Complete duplication may be result of two ureteral buds from single mesonephric duct. We report a case of unilateral complete ureteral duplication with ureterocele formation in a 41 year old woman presented with abdominal pain.

Introduction

Duplex renal system is described as the kidney has two pyelocaliceal systems with single, bifid (partial ureteral duplication) or double ureter (complete ureteral duplication) draining into the bladder [1]. The incidence of duplex renal system ranges from 0.5-3%. Complete ureteral duplication is more rarely seen when compared to single ureter or partial duplication. The patients with complete ureteral duplication have other congenital anomalies such as short lower moiety intramural ureter causing vesicoureteral reflux or upper moiety ureter with a ureterocele [2]. Here we report a case of complete duplication of ureter with ureterocele in an adult women.

Case

A 41 year old woman presented with abdominal parin during one month. The ultrasonographic imaging showed mild hydronephrosis in right kidney and cystic lesion in bladder that suspected ureterocele. Intravenous urography was done but double ureter was not visualized because of hipofunctional kidney. Cystoscopy was revealed the cystic lesion near the right ureteral orifice (Figure 1). Retrograde pyelography was showed lower pole of the kidney (Figure 2). Transurethral resection was performed and second ureter was visualized (Figure 3), double j stent and ureteral cathater was inserted seperately (Figure 4). No complication was occured in peroperative and postoperative period. The patient was discharged one day after the operation and has no complaint during two months follow up.

Discusion

Ureteral duplications are the result of premature splitting of the ureteric bud, a remmant of the Wollfian duct [3]. Partial duplication is observed in metanephric tissue that has not seperately fully, but complete duplication may be result of two distinct ureteric buds. Complete duplication is approximetely one third as common as partial duplication. Weigert Mayer law is observed in complete ureteral duplication cases [4]. The ectopic ureter arives from upper moiety is inferior and medial as compared to the lower pole moiety’ s ureter may have ureterocele formation. Ureterocele is described as congenital pseudocystic dilatation of the intravesical ureter that results from a malformation of the submucosa of the bladder [5].

Presentation of duplication is variable and highly dependent on age. The patients can present with repeated urinary tract infections, hematuria,abdominal or flank pain [5]. Approximetely, half of the patients with duplication identified prenatally and present with repeated urinary tract infections and 10% of the children with such infections have this condition. In adults, vesicoureteral reflux and recurrent infections are main symptoms.

The ureterocele sometimes prolopsed into the urethra that resulted bladder outlet obstruction with acute urinary retention [4]. Conservative management or endoscopic treatment is the first choice therapy in infancy.The other treatment modalites are transurethral resection and heminephrectomy with upper ureterectomy [5]. In this study the patient that was diagnosed with ultrasonograpy and treated with transurethral resection. The clinicans should be kept in mind that complete ureteral system can be diagnosed in adult patients with non specific symptoms.

1Karakose A, Aydogdu O, Atesci YZ (2013) Unilateral complete ureteral duplication with distal ureteral stone: A rare entity. Can Urol Assoc J 7: E511-E512.
2Aiken WD, Johnson PB, Mayhew RG (2015) Bialteral complete ureteral duplication with calculi obstructing both limbs of left double ureter. Int J Surg Case Rep 6: 23-25.
4Fufezan O, Tatar S, Dee AN, Cramariue R, Asavoaie C, et al. (2013) Large spectrum of complete urinary collecting system duplication exemplified by cases. Pictorial essay. Med Ultrason 15: 315-320.
5Adorisio O, Elia A, Landi L,Taverna M, Malvasio V, et al. (2011) Effectiveness of primary endoscpic ıncision in treatment of ectopic ureterocele associated with duplex system. Urology 77: 191-194.
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