Vaginal ureterocele: Rare finding in complicated pyelonephritis

Abstract

Introduction: Pyelonephritis is a urinary tract infection that can frequently be complicated by anatomical abnormalities such as in ectopic ureteroceles, pathologies which are rare in the literature. Case Report: A 23-year-old woman with a clinical history, physical and laboratory examinations compatible with pyelonephritis was admitted. Ultrasonography revealed a ureterocele and hydronephrosis of the upper collecting system of the left kidney. We evoked a complicated pyelonephritis and the patient underwent a computed tomography (CT) scan that confirmed bilateral pyelocalyceal and ureteral duplicity, pyonephrosis, and implantation of the upper ureter of the left kidney into the vaginal dome, forming a left ureterocele. The patient was placed on antibiotics and the ureterocele was drained through the vaginal canal. After twelve days of hospitalization, she underwent an open partial nephrectomy of the upper portion of the left kidney. On the third postoperative day, she was asymptomatic and was discharged. Conclusion: Despite the typical clinical picture of complicated pyelonephritis, this case stands out for the unusual and challenging anatomical findings, such as the pyelocalyceal bilateral duplicity and a rare infected ectopic ureterocele with vagina implantation. These challenging findings required transvaginal drainage and heminephrectomy, what shows that anatomical rare abnormalities can be hidden in a typical clinical presentation of pyelonephritis and demand an intense radiologic investigation and unusual treatments.