2012, Number 1
Rev Mex Urol 2012; 72 (1)
Fulda-Graue S, Santana-Rios Z, Pérez-Becerra R, Urdiales-Ortiz A, Martínez JA, Fernández-Noyola G, Ahumada-Tamayo S, Muñoz-Ibarra EL, García-Salcido FJ, Camacho-Castro A, Cantellano-Orozco M, Martínez-Arroyo C, Morales-Montor G, Pacheco-Gahbler C
PDF size: 866.36 Kb.
ABSTRACTIntroduction: Complicated bladder exstrophy can be divided into pseudoexstrophy, covered bladder exstrophy, bladder fissure, and double bladder. Double bladder is extremely rare and consists of two bladder chambers separated by a complete fibromuscular wall, with or without double urethra. It is frequently accompanied by congenital abnormalities. Each bladder receives an ipsilateral ureter and drains into an independent urethra. The objective of this article was to present a case of complicated bladder exstrophy with genitourinary duplication, hydronephrosis, and vesicoureteral reflux, along with its management.
Clinical case: Patient is a twenty-year-old woman with past medical history of bladder exstrophy with spontaneous closure. Physical examination revealed ambiguous genitals and double clitoris, double vagina, and double uterus. Patient presented with right flank pain and palpable mass. Computed tomography scan showed right renal hydronephrotic sac, two bladders with independent urethras, and uterus didelphys. Cystography revealed complete double bladder and the presence of right vesicoureteral reflux.
Cystoscopy correlated non-communicating bladders and independent urethras. Complete double genitourinary system was diagnosed along with vesicoureteral reflux and functional exclusion of right kidney. Right nephroureterocystectomy was carried out and patient progression was satisfactory.
Conclusions: Fewer than fifty cases of double bladder have been reported and duplication can be complete or partial and sagittal or coronal. There is genitourinary duplication in the majority of cases. Other associated abnormalities are double penis, double vagina, and double uterus. Surgical correction is the treatment of choice in the majority of patients, providing good results and favorable prognosis.