Obstructing calculus in a single limb of a duplicated ureter: A Recall of the surgical anatomy and the Variable Ureter Anomalies

Shawish Fa,Shawish Wa

doi:10.36502/2019/asjbccr.6156

Shawish Fa, Shawish Wa

Open Access

https://doi.org/10.36502/2019/asjbccr.6156

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Abstract

The ureter is a common site of congenital anomalies which may be associated with a considerable morbidity particularly among young patient. The congenital anomalies of the ureter coexist with multitude of other urinary tract anomalies but it may occur independently. It is more common in females. The complete duplication of the ureter may not produce symptoms which would suggest the presence of malformation. Therefore, such anomaly may not become apparent until later in life. Further, this anomaly might not be recognized prior to the surgery and hence, missing of the stone is highly possible. Herein we present a case of complete ureter duplicate with an obstructive stone located close to VUJ of one limb of the duplicate. A sound knowledge of the surgical anatomy and of the congenital ureter anomalies is essential for correct diagnosis and appropriate management.

Highlights

The ureter is a derivative of the wolffian duct
A combination of genetic mutation and environmental factors contribute to the formation of urinary tract anomalies [1,2].Ureter duplication is inherited by an autosomal dominant gene of variable penetration [3]
The complete duplication is present in approximately in 1 from 125 individual [6].It is more common in females than males with a ratio of 2:1 [5].In the English literature few cases of calculi found in one limb or in the two limbs of the duplicated ureter [8,9]

Summary

Introduction

The ureter is a derivative of the wolffian (mesonephric) duct. Ureteral bud branches off from the caudal portion of Wolffian duct at the fourth and fifth week of gestation. We present an additional case of complete duplicated left ureter with an impacted calculus found in a single limb of the duplicate. A 22year old female patient in the last month she repeatedly attended the emergency room (ER) with a complaint of left sided abdominal pain, dysuria and difficulty in urine void Her abdomen was mildly tender on the left iliac fossa. A thorough cystoscopy guided us to a pinpoint, with small caliper, congested and edematous another orifice 1cm inferior and medial to the normally located orifice (weigert- Mayer law applies) (Fig-3) This second left VUJ orifice was poorly. It led us to the second limb of the duplicated left ureter with an impacted stone encountered inside and just close to the ureteric orifice of this limb (Fig-4).The calculus broken with holmium laser and the fragments were removed with complete clearance. The catheters were removed day and she discharged after spontaneous void

Discussion

Conclusion