Urology: Ureter Anatomic Anomalies

Ureteral Duplication (Duplex Kidney)

Definitions

  • Definition: Two Ureters Originating from the Same Kidney
  • Classification:
    • Complete: Two Separate Pelvicalyceal Systems & Ureters with Separate Insertions
      • Insertion Can Be in the Bladder (Most Common) or Ectopic
    • Partial (Most Common): Two Separate Systems Combine Prior to Bladder Insertion
  • Most Common Urinary Tract Abnormality

Sites of Ectopic Insertion

  • Boys:
    • Posterior Urethra
    • Ejaculatory Ducts
    • Epididymis
  • Girls:
    • Vagina
    • Uterus

Presentation

  • Chronic/Recurrent UTI
  • Hydronephrosis
  • Obstruction
  • Incontinence

Diagnosis

  • Diagnosis: Imaging (US, CT/MRI or Voiding Cystourethrogram)

Treatment

  • Asymptomatic: None
  • Symptomatic or Dilation: Surgical Repair
    • Reimplantation, Ureteroureterostomy or Reconstruction
    • May Require Partial or Complete Nephrectomy

Ureteral Duplication Diagram 1

Bilateral Ureteral Duplication on IV Urogram 2

Ureterocele

Definitions

  • Definition: Cystic Dilation of the Terminal Ureter
  • Classification:
    • Intravesical: Completely in the Bladder
    • Ectopic: Extends into the Urethra
  • Most Common in White Females

Presentation

  • *Often Seen Incidentally on Antenatal Ultrasound
  • UTI
  • Urolithiasis
  • Intermittent Abdominal/Pelvic Pain
  • Failure to Thrive

Diagnosis

  • Primary Diagnosis: US
  • Evaluate for Vesicoureteral Reflux (VUR) with Voiding Cystourethrography (VCUG)

Treatment

  • Primary Treatment: Surgical Repair
  • Endoscopic Incision (Most Common) vs Open Reconstruction

Ureterocele 3

References

  1. Boer L, Radziun AB, Oostra RJ. Frederik Ruysch (1638-1731): Historical perspective and contemporary analysis of his teratological legacy. Am J Med Genet A. 2017 Jan;173(1):16-41. (License: CC BY-NC-ND-4.0)
  2. Morhason-Bello IO, Adebayo SA, Abdusalam RA, Bello OO, Odubamowo KH, Lawal OO, Olapade-Olaopa EO, Ojengbede OA. Bilateral double ureters with bladder neck diverticulum in a nigerian woman masquerading as an obstetric fistula. Case Rep Urol. 2014;2014:801063. (License: CC BY-3.0)
  3. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. (License: CC Unspecified)