A 52-Year-Old Male with Bilaterally Duplicated Collecting Systems with Obstructing Ureteral Stones: A Case Report

Scantling, Dane; Ross, Curtis; Altman, Howard

doi:10.1159/000356257

Cited by 17 publications

(20 citation statements)

References 7 publications

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“…Complete ureteral duplication constitutes the most scarce ureteral aberration that can either present bilaterally or unilaterally and represents the 33% of incomplete duplications [2]. All forms of renal duplication have a 2:1 female predominance [3].…”

Section: Introductionmentioning

confidence: 99%

Complete unilateral ureteral duplication encountered during intersphincteric resection for low rectal cancer

Varlatzidou

Zarokosta

Nikou

et al. 2018

Journal of Surgical Case Reports

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Complete duplication of ureters is a very rare clinical entity that may either be asymptomatic or present with a variety of clinical findings. In the presented case a 51-year-old Caucasian female underwent an intersphincteric resection for low rectal cancer. Intraoperatively, during the standard bilateral recognition and mobilization of the ureters, complete unilateral duplication of the left ureter was incidentally detected, deriving from a single renal parenchyma. Such a congenital abnormality though constitutes a major risk-factor of accidental ureteral injury during operations including pelvis. Conclusively, meticulous exposure of both ureters combined with surgeons’ unceasing awareness constitute the cornerstone of a safe operation.

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Section: Introductionmentioning

confidence: 99%

Complete unilateral ureteral duplication encountered during intersphincteric resection for low rectal cancer

Varlatzidou

Zarokosta

Nikou

et al. 2018

Journal of Surgical Case Reports

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“…A literature search identified just one result of a patient with complete left duplication and partial right duplication with obstructing calculi on both sides. 5 We report the first case of bilateral partial duplication and bilateral obstruction, and the first case caused by malignant external compression.…”

Section: Discussionmentioning

confidence: 94%

Bilateral obstruction of bilaterally duplicated collecting systems requiring upper and lower moiety drainage

Lynch

Cox

Rawal

et al. 2016

annals

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A 60-year-old woman with a history of breast cancer presented with bilateral obstruction of bilaterally duplicated renal collecting systems secondary to extrinsic compression from metastatic pelvic lymphadenopathy. Bilateral JJ ureteric stents were inserted, resulting in some improvement of renal function but a failure to normalise completely. Repeat computed tomography demonstrated bilateral duplex collecting systems with persisting obstruction of the undrained moieties. Selective puncture was performed to decompress the obstructed renal moieties for bilateral nephrostomy catheter insertion. This allowed renal function to improve sufficiently for the patient to be discharged and commence chemotherapy. This is the first reported case of bilaterally obstructed partially duplicated collecting systems and it illustrates the importance of recognising anatomical variants to tailor treatment appropriately. It also highlights the important relationship between urology and interventional radiology in the management of such complex patients. KEYWORDSInterventional radiography -Kidney tubules -Collecting systems -Abnormalities -Urology Case historyA 60-year-old woman presented with abdominal pain and acute kidney injury. On admission, urea was recorded as 15mmol/l (normal: 2.5-7.8mmol/l) and creatinine as 243µmol/l (normal: 49-90µmol/l). Five years previously, the patient had been diagnosed with invasive ductal carcinoma of the left breast (grade 3, T3 N1 M0), and had undergone a mastectomy and axillary clearance (4/14 nodes positive) followed by adjuvant chemoradiotherapy. She was otherwise independent without significant co-morbidity.Ultrasonography identified bilateral hydronephrosis and computed tomography (CT) confirmed distal ureteric obstruction secondary to extrinsic compression by metastatic pelvic lymphadenopathy (Figs 1 and 2). CT also revealed lumbar spine metastatic disease, bilateral pleural effusions, ascites and peritoneal disease (Fig 2). Positron emission tomography CT demonstrated high uptake in the pelvic lymph nodes, consistent with local metastasis, thought to be the cause of her ureteric obstruction (Fig 3). Subsequently, bilateral JJ ureteric stents were inserted under general anaesthesia (Fig 4). During cystoscopy and retrograde ureterography, no anatomical abnormalities were identified, and the guidewires and stents passed without difficulty into the renal A B ONLINE CASE REPORT Ann R Coll Surg Engl 2016; 98: e55-e58

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“…A combination of genetic mutation and environmental factors contribute to the formation of urinary tract anomalies [1,2].Ureter duplication is inherited by an autosomal dominant gene of variable penetration [3]. The highest prevalence has been reported in Caucasian females [4,5]. Duplication of the ureter may be incomplete (bifid ureter) or complete in which each limb of the duplicate open separately in the bladder and this is a rare anomaly [6,7].The VUJ orifice of the limb which drain the upper renal moiety (the first limb of the duplicate) has ectopic insertion usually medial and inferior to the lower pole moiety ureter (the second limb of the duplicate) which has orthotopic insertion in the bladder (Weigert-Mayer law) [1].…”

Section: Introductionmentioning

confidence: 99%

Obstructing calculus in a single limb of a duplicated ureter: A Recall of the surgical anatomy and the Variable Ureter Anomalies

Fa¹,

2019

Asp Biomed Clin Case Rep

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The ureter is a common site of congenital anomalies which may be associated with a considerable morbidity particularly among young patient. The congenital anomalies of the ureter coexist with multitude of other urinary tract anomalies but it may occur independently. It is more common in females. The complete duplication of the ureter may not produce symptoms which would suggest the presence of malformation. Therefore, such anomaly may not become apparent until later in life. Further, this anomaly might not be recognized prior to the surgery and hence, missing of the stone is highly possible.Herein we present a case of complete ureter duplicate with an obstructive stone located close to VUJ of one limb of the duplicate. A sound knowledge of the surgical anatomy and of the congenital ureter anomalies is essential for correct diagnosis and appropriate management.

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A 52-Year-Old Male with Bilaterally Duplicated Collecting Systems with Obstructing Ureteral Stones: A Case Report

Cited by 17 publications

References 7 publications

Complete unilateral ureteral duplication encountered during intersphincteric resection for low rectal cancer

Complete unilateral ureteral duplication encountered during intersphincteric resection for low rectal cancer

Bilateral obstruction of bilaterally duplicated collecting systems requiring upper and lower moiety drainage

Obstructing calculus in a single limb of a duplicated ureter: A Recall of the surgical anatomy and the Variable Ureter Anomalies

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