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

Abstract

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.

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

“…Some cases of ureteral duplication with ureterocele stone have been reported [5,7].A similar cases of duplex were also detected in a research study and another seen during a routine dissection of a cadaver [6,11]. Generally speaking most of the aberrations detected incidentally during URS surgery for obstructing stone or during other pelvic organ surgery [5]. Herewith we present an additional case of complete duplicated left ureter with an impacted calculus found in a single limb of the duplicate.…”

“…Ureteral duplication usually is asymptomatic and its diagnosis is incidental. It can be associated with urinary tract infection, vesicoureteric reflux, ureterocele, stone formation, obstructive uropathy, ectopic ureter and other congenital complications [3,5,7]. In such cases renal morphology, ureteral condition and renal function warranted to be evaluated.The initial evaluation of a patient with a suspected obstructive stone usually occur in the emergency room (ER).…”

“…More few cases reported with bilateral ureteric duplication in which stones were found in all of the limbs of the duplicate [10]. Some cases of ureteral duplication with ureterocele stone have been reported [5,7].A similar cases of duplex were also detected in a research study and another seen during a routine dissection of a cadaver [6,11]. Generally speaking most of the aberrations detected incidentally during URS surgery for obstructing stone or during other pelvic organ surgery [5].…”

“…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].…”

“…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]. The complete duplication is present in approximately in 1 from 125 individual [6].It is more common in females than males with a ratio of 2:1 [5].In the English literature few cases of calculi found in one limb or in the two limbs of the duplicated ureter [8,9]. More few cases reported with bilateral ureteric duplication in which stones were found in all of the limbs of the duplicate [10].…”