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
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 . 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 . Here we report a case
of complete duplication of ureter with ureterocele in an adult
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.
Ureteral duplications are the result of premature
splitting of the ureteric bud, a remmant of the Wollfian duct
. 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 . 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 .
Presentation of duplication is variable and highly
dependent on age. The patients can present with repeated urinary
tract infections, hematuria,abdominal or flank pain .
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 . Conservative management or endoscopic
treatment is the first choice therapy in infancy.The other
treatment modalites are transurethral resection and heminephrectomy
with upper ureterectomy . 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.