Artificial Urinary Sphincter With Bilateral Atrophic Kidneys and Accessory Renal Arteries in a Male Cadaveric Subject: A Case Report and Clinicopathological Reconciliation of Urinary Abnormalities and Embryogenetic Correlation of Vascular Aberrations

Abstract

A unique combination of triple abnormality in a willed male body donor dissection, with putative clinicopathological correlations during the subject's lifetime, is described in this case report. The subject had a three-piece artificial urinary sphincter surgically implanted around the proximal corpus spongiosum, left scrotal pouch and in the lower left abdominal wall, ostensibly for urinary incontinence during his lifetime, though the etiology of the latter was not immediately obvious. He also had a total of three accessory renal arteries involving both sides, complicated by bilateral diffuse renal atrophy from presumable glomerulosclerosis or nephrosclerosis-induced nephrotic syndrome. While each entity may not be so unique per se, each is not too common either. The combination of all three findings has not been described to date in the contemporary literature in a single male cadaver dissection. Only seven reports of artificial urinary sphincter studies on human cadaver subjects could be detected in contemporary literature, this being the eighth. Finally, there were no apparent etiopathological or pathogenetic mechanisms to explain the occurrence of each or the coexistence of all of them in a single male cadaveric subject. The artificial urinary sphincter was reviewed with respect to its characteristics, placement, and efficacy. An attempt was made to establish the cause-effect relationship between the artificial sphincter and urinary incontinence that necessitated the implant. Thereafter, a clinicopathological correlation was proposed in this case report to reconcile the concomitance of urinary incontinence, bilateral accessory renal arteries, and bilateral renal atrophy. An embryogenetic mechanism of the aberrant renal arteries was also suggested. Physician awareness from the standpoint of preoperative investigation of such cases was also highlighted.