Congenital Dysplastic Kidney with Ectopic Ureter to the Uterine Cervix

Abstract

Study Objective To describe a unique presentation of a patient with an ectopic ureter to the uterine cervix, and its associated congenital dysplastic kidney. To highlight relevant anatomy, demonstrate the surgical technique used to identify and treat the ectopic ureter. Design Video case report. Setting Operating room at an academic hospital. Patients or Participants Single surgical patient. Interventions Endoscopic resection of dysplastic kidney and ectopic ureter. Measurements and Main Results We describe the unusual presentation of a 40-year-old female who was referred to our facility due to the complaint of 6-months of tissue protruding from her vagina. She was noted to have an anterior vaginal mass. In office cystovaginoscopy revealed no left ureteral orifice and large cystic mass adjacent to the cervix on the left. Imaging confirmed the dysplastic left kidney with an ectopic ureter to the uterine cervix associated with a left sided paracervical and paravaginal abscesses. The patient subsequently underwent an uncomplicated robotic-assisted nephrectomy and complete excision of the ureter as well as paravaginal and paracervical abscesses utilizing a multidisciplinary approach. Conclusion In this video case report, we demonstrate a successful surgical technique to identify and excise an ectopic ureter and paravaginal/paracervical abscesses using a multidisciplinary approach with combined nephrectomy. This presentation reviews the pertinent pelvic anatomy and highlights the importance of complete resection of an ectopic ureter at the time of nephrectomy for a dysplastic kidney to prevent recurrence of abscess at the location of the insertion point of the distal ureter. To describe a unique presentation of a patient with an ectopic ureter to the uterine cervix, and its associated congenital dysplastic kidney. To highlight relevant anatomy, demonstrate the surgical technique used to identify and treat the ectopic ureter. Video case report. Operating room at an academic hospital. Single surgical patient. Endoscopic resection of dysplastic kidney and ectopic ureter. We describe the unusual presentation of a 40-year-old female who was referred to our facility due to the complaint of 6-months of tissue protruding from her vagina. She was noted to have an anterior vaginal mass. In office cystovaginoscopy revealed no left ureteral orifice and large cystic mass adjacent to the cervix on the left. Imaging confirmed the dysplastic left kidney with an ectopic ureter to the uterine cervix associated with a left sided paracervical and paravaginal abscesses. The patient subsequently underwent an uncomplicated robotic-assisted nephrectomy and complete excision of the ureter as well as paravaginal and paracervical abscesses utilizing a multidisciplinary approach. In this video case report, we demonstrate a successful surgical technique to identify and excise an ectopic ureter and paravaginal/paracervical abscesses using a multidisciplinary approach with combined nephrectomy. This presentation reviews the pertinent pelvic anatomy and highlights the importance of complete resection of an ectopic ureter at the time of nephrectomy for a dysplastic kidney to prevent recurrence of abscess at the location of the insertion point of the distal ureter.