Giant hydronephrosis secondary to an ectopic ureter associated with bilateral duplex collecting system: a case report

Abstract

Giant hydronephrosis is an ultimate rare urologic entity; even rarer when it is secondary to a duplex collecting system. Duplex collecting system is a common urologic anomaly with a wide range of clinical symptoms and a variety of associated urologic abnormalities such as an ectopic ureter, ureterocele, vesicoureteral reflux and ureteropelvic junction obstruction. This report presents a case of an 8-year-old boy who had a bilateral duplex collecting system that was revealed accidentally by a bilateral severe hydronephrosis. The duplication was complete on the left side and partial on the right with a right ectopic ureteral orifice, in addition to a bilateral vesicoureteral reflux. The vesicoureteral reflux retreated completely in the left side after using a urethral catheter for 6 months, while the decision of performing a surgical operation for the right side was made.

Surgical Management of Bilateral Single-System Ectopic Ureters (BSSEUs) in a Pediatric Patient: A Report of a Rare Case and Literature Review

“…Persistent urinary incontinence in females post-toilet training should raise suspicion of ectopic ureter [ 8 ]. Diagnosis usually occurs during early childhood, necessitating imaging for confirmation [ 9 ]. While ultrasound (USG) is often the initial diagnostic tool, CT urography and MRI with urography are preferred for definitive diagnosis due to their superior ability to delineate anatomical relationships.…”

Bilateral complete duplication of ureter with ectopic ureter presenting as persistent urinary dribbling with normal voiding pattern in 17-year-old female: Case report

“…One should suspect an ectopic ureter in female with persistent urinary incontinence and normal voiding pattern following toilet training [ 13 ].Most cases are diagnosed in early childhood [ 1 ]. Imaging diagnostic modalities are must to confirm the diagnosis in all cases [ 14 ]. Ultrasound shows dual pelvises or hydronephrosis particularly in lower pole during prenatal scan when ureteropelvic junction obstruction is present [ 10 ].…”

“…Ultrasound is an excellent diagnostic modality after birth; asymmetry between two sides indicates unilateral duplication while non uniform hydronephrosis between upper and lower poles indicates complete duplication and uniformity is non conclusive [ 15 ]. Complete duplication without obstruction may evade ultrasound detection and ultrasound almost never detect an ectopic insertion of the ureter as it does not clearly delineate the anatomical relationship between ureter, bladder, urethra and vagina [ 14 , 16 ]. In such cases, contrast-enhanced computed tomography (CT) or magnetic resonance imaging urography should be used to detect or rule out an ectopic ureter [ 16 ].…”

“…Micturating cystourethrogram (MCUG) could detect vesicoureteral reflux [ 10 ]. Cystoscopy could help in detecting anomalies like ectopic ureter [ 14 ]. Surgery is the best available treatment as it resolves the incontinence, prevent complications and preserve renal functions.…”