Juárez-Hernández DA, Acuña-Alberto A, Flores-Terrazas JE, Castro-Marín M, López-Silvestre JC, Campos-Salcedo JG, Zapata-Villalba MA, Mendoza-Álvarez LA, Estrada CCE

Language: Spanish
References: 12
Page: 230-234
PDF size: 436.30 Kb.

ABSTRACT

Background: Double ureter is the most common congenital anomaly of the urinary tract. It can be associated with other developmental abnormalities of the renal and genital system due to its close relation to the latter. Even though it can be asymptomatic, it is most frequently associated with vesicoureteral reflux.
Case presentation: Patient is a 57-year-old woman with past history of recurrent urinary tract infection since childhood. She began to present with urinary tract infection again five years prior and was managed with multiple antimicrobial regimens, but symptomatology persisted. Excretory urography identified radio-opaque image suggestive of left kidney stone and two more in right paravertebral location at L4 level. In addition, bilateral double collecting system image was identified. The right system had contrast medium amputation in lateral ureter that ended at the tip of the abovementioned radio-opaque image. There was adequate passage of contrast medium in medial ureter and no dilation was apparent in left ureters. Surgical management with right flexible ureteroscopy was planned, and retrograde pyelography was done in lateral ureter that identified yellowish spiculated stone under direct vision with flexible ureteroscope. It was fragmented with Holmium laser. Second surgery was planned and rigid and flexible ureteroscopy were carried out for residual lithiasis in inferior third of right lateral ureter and ipsilateral kidney stone in the inferior calyx, completely resolving both. Patient is currently asymptomatic and is under surveillance at outpatient service of the authors’ institution where she is undergoing conservative management of left renal lithiasis.
Conclusions: The present authors believe that patients with associated lithic disease do not require treatment or postoperative care that varies from the norm. Rigid or flexible ureteroscopy or percutaneous nephrolithotomy can be carried out in patients with this disease.

REFERENCES

1. Hawthorne AB. The embryologycal and clinical aspect of double ureter, Department of Urology, Royal Victoria Hospital, Montreal. Can Med Assoc J 1936;34:21-6.

2. Nation EF. Duplication of the kidney and ureter: a statistical study of 230 new cases. J Urol 1944;51:456-465.

3. Phillips DI. A geographical focus of duplex ureter. Br J Urol 1987;60:329-31.

4. Barnes DG. The dúplex uréter in Burnley, Pendle and Rossendale. Br J Urol 1989;64:345-6.

5. Emil A Tanagho. Urologia General de Smith. 13ª ed. Edit. Manual Moderno. México. 2005.

6. Cambell-Walsh. Urologia 9a ed, Edit. Panamericana. México. 2008.

7. Moore Kl, embriología clínica, 2ª ed., Edit. Manual Moderno. México. 1979.

8. Keane T, Owens A, Kelly D. Bilateral Obstructed Extopic Duplex Ureter. Br J Urol 1987;60:82-3.

9. Garza MM. Riñón en herradura con doble sistema colector completo derecho. Reporte de un caso. Rev Mex Urol 2004;64:238-41.

10. Bisset GS, Strife JL. The Duplex Colectin System in Girls with Urinary Tract Infection: Prevance and significance. AJR Am J Roentgenol 1987;148:497-500.

11. Share JC, Lebowitz RL. The unsuspected double collecting system on imaging studies and at cystoscopy. AJR Am J Roentgenol 1990;155:561-4.

12. Torrecilla Ortiz C, Colom Feixas S. Current treatment of lithiasis in congenital renoureteral malformations. Arch Esp Urol 2001;54:926-36.