Obstruction of bifid ureter by two calculi

Abstract

Rationale:The duplex ureter is a common anomaly of urinary tract, but preoperative sonography, plain abdominal radiography, or nonenhanced computed tomography (CT) often overlooked it when involved with urinary tract obstruction. In this report, We present a rare case of left Y-shaped bifid ureter and both ureter of upper moiety and common stem were obstructed respectively by 2 calculi.Patient concerns:A 47-year-old woman was admitted due to 3-day history of left-sided loin pain and low-grade fever. The patient was diagnosed with right renal atrophy and 2 calculi of left ureter associated with severe left hydronephroureterosis, and underwent left percutaneous nephrostomy and left ureterolithotomy without identification of the upper calculus in left ureter in another hospital.Diagnoses:After transfer of the patient to our hospital, preoperative contrast-enhanced CT detected the left Y shaped bifid ureter and the calculus in upper moiety ureter.Interventions:The migrated calculus was extracted by left ureterolithotomy.Outcomes:The patient discharged uneventfully.Lessons:Contrast-enhanced CT should be recommended prior to any surgical procedures involved with upper urinary tract to exclude duplex ureter.

Incomplete ureteral quintuplication obstructed by proximal calculus: Case report and review of literature

“…Abnormalities in this site might result in complete or incomplete duplicated ureters or ectopic ureter. Around the 5th week of pregnancy, the ureteric bud arises into the mesonephric duct and when ureteric bud rotates a failure may be present as duplicated or ectopic ureters [1] , [4] , [6] .…”

“…Other complications reported in literature are urinary tract infection, pyelonephritis, reflux and stenosis. Quadruplication of the ureter is the rarest multiplicity anomaly with only few reports in the literature, some associated with ureteral cyst [6] , [7] , [8] , [9] , [10] , [11] , [12] .…”

Multi Imaging Modality in Diagnosis of Unusual Giant Hydronephrosis of the Non Functioning Lower Moiety in A Partial Duplex Kidney with Distal Ureteric Stricture

“…Complex duplex renal systems may require further evaluation using cross-sectional imaging, which include CT Urography and MR Urography providing comprehensive morphologic and functional evaluation of complex duplex kidneys [36,37]. Non contrasted CT is useful in detecting presence of calculi causing Pelvic Ureteral Junction (PUJ) or ureteric obstruction [2,38]. Prolonged-delay enhanced CT Urographyis useful for exposing the entire course of the duplicated ureters and existing complications, assessment of the residual parenchyma and also demonstrating the crossing vessels before surgical planning [32,39,40].…”

“…Duplex collecting system of the kidney is a common congenital anomaly of the urinary tract, with an incidence of 0.8 -1% [1][2][3]. They are bilateral in 20% of cases and are almost twice as common in females as males.…”

Anatrophic nephrolithotomy and pyelolithotomy for dual staghorn calculi in bifid collecting system

“…This anomaly is in a continuum of duplex collecting systems and most commonly involves a common distal ureter. This is usually asymptomatic and is predominantly an incidental diagnosis, nevertheless, is a potential risk factor for urolithiasis formation [ 4–6 ]. Current surgical management of larger staghorn calculi favours percutaneous nephrolithotomy (PCNL) over traditional open surgery [ 7 , 8 ].…”