Duplicated Collecting System

Abstract

Study Objective The objective of this video is to discuss the presentation, evaluation, and treatment of duplicated urinary collecting systems, and to present a case of duplicated ureters with ectopic ureteral implantation at the vaginal introitus. Design N/A Setting N/A Patients or Participants We present the case of a 56 year-old presenting with a history of recurrent urinary tract infections starting in adolescence. She reported symptoms of urinary urgency, frequency, and incontinence. She additionally reported an unclear history of an incidental diagnosis of ureteral anomaly in childhood. Interventions For evaluation of this patient, a computed tomography urogram was performed which revealed a right duplicated kidney with upper ureter inserting into the bladder neck, and lower ureter with unclear course. A voiding cystogram was performed to evaluate for ureteral reflux which was not demonstrated. A renal MAG3 scan was performed and demonstrated differential function between the two right renal moieties but no evidence of obstruction to the outflow tract to either renal moiety. Exam under anesthesia, cystoscopy, and right retrograde pyelogram revealed an ectopic ureteral orifice at the vaginal introitus and mild hydroureter leading to the upper renal moiety. Measurements and Main Results Complete mapping of this patient's right collecting system revealed complete ureteral duplication with the lower renal moiety drained by a normal ureter leading to an orthotopic ureteral orifice and the upper renal moiety draining into a mildly dilated ureter leading to an ectopic ureteral orifice at the vaginal introitus. The patient will subsequently undergo robotic-assisted right ureteroureterostomy and excision of distal ectopic ureter in a combined laparoscopic and vaginal approach. Conclusion Duplicated urinary collecting systems are the most common birth defect related to the urinary tract and can be frequently encountered by the pelvic surgeon. Knowledge of the presentation and workup of these anomalies is important in determining appropriate treatment.