Robotic partial nephrectomy for duplex kidney with ectopic ureter draining in the vagina in an adult patient with urinary incontinence

Abstract

A duplex kidney system with an ectopic ureter draining into the vagina is a congenital malformation that typically presents as refractory urinary incontinence. Diagnosis is often difficult to establish and delayed due to a low incidence. We present the case of a patient aged 26 years with a life-long history of persistent urinary incontinence. Initial presentation was at childhood; however, the diagnosis went undetermined for 22 years. CT urography revealed a duplex kidney with an atrophic upper pole associated with an ectopic ureter that drained into the vaginal vault. This is the first description of such a case being managed successfully via a robot-assisted partial nephrectomy approach. Ectopic ureteral duplication should be considered in the differential diagnosis for young women with refractory urinary incontinence. Robotic partial nephrectomy is a safe and effective technique to manage such cases.

Urinary Incontinence in Adulthood in a Course of Ectopic Ureter—Description of Two Clinical Cases with Review of Literature

“…We only found 20 results, most of which were single case reports. Urinary leakage, reported in most of case reports, was lifelong and related to vaginal insertion [ 20 , 21 , 22 , 23 , 24 ]. Only one article of Fichtenbaum at al.…”

Ectopic insertion of a duplicated ureter into the prostatic urethra

“…(3,7) La urografía intravenosa y la cistografía miccional pueden complementar el diagnóstico con la visualización anatómica del uréter y su sitio de implantación. (3,9) La TAC abdominal contrastada tiene una especificidad muy elevada. Proporciona los detalles de la anatomía del uréter y su sitio de inserción, e información para la planificación del tratamiento quirúrgico.…”

“…Se utilizan diferentes abordajes: la cirugía abierta, la cirugía laparoscópica o robótica. (9,11,12) En el tratamiento de los pacientes con uréter ectópico, la decisión debe estar basada en la función de la unidad renal. Si la función del polo superior está conservada, se puede realizar la urétero-ureterostomía proximal o el reimplante ureteral.…”

Diagnosis and surgical outcomes of ectopic ureters in adults: A case series and literature review

“…Ectopic ureters are a rare diagnosis in adults, and symptoms are often nonspecific. As such, diagnosis remains a significant challenge for clinicians, requiring a combination of detailed history and clinical examination, contrast‐enhanced cross sectional imaging and cystoscopy of the urinary tract …”

“…a combination of detailed history and clinical examination, contrast-enhanced cross sectional imaging and cystoscopy of the urinary tract. [4][5][6] The published literature focuses primarily on surgical techniques, with limited data on presentation, diagnostics and functional outcomes. We describe a series of 10 adult patients referred to a tertiary unit for urinary incontinence with subsequent assessment confirming an ectopic ureter.…”