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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 19  |  Issue : 2  |  Page : 148-150

Unilateral isolated incompletely duplicated ureter


Department of Anatomy, Mahatma Gandhi Institute of Medical Sciences (M.G.I.M.S), Sevagram, Wardha, Maharashtra, India

Date of Web Publication11-Aug-2014

Correspondence Address:
Yuganti P Vaidya
Department of Anatomy, Mahatma Gandhi Institute of Medical Sciences (M.G.I.M.S), Sevagram, Wardha, Maharashtra - 442102
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9903.138442

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  Abstract 

The aim of this study was to report a congenital anomaly in a cadaveric dissection. During routine undergraduate dissection in a middle-aged male cadaver, we found that on the left side, there was a presence of an incompletely duplicated ureter. On the right side the ureter was single in its whole extent. No other congenital anomaly was found to be associated with this. The two limbs of the left ureter joined at about a distance of 5 cm from the bladder wall.
A duplicated ureter is commonly found in association with other congenital anomalies and defects. The present case report describes a rare case of an isolated duplicated ureter with a normal kidney, urinary bladder, and renal vessels. This case report adds on to the literature and will be helpful and interesting for the surgeons. The possible embryological reasons for the formation of a duplicated ureter will be discussed.

Keywords: Duplication, kidney, ureter, urinary bladder


How to cite this article:
Vaidya YP, Waghmare JE, Tarnekar AM, Shende MR. Unilateral isolated incompletely duplicated ureter. J Mahatma Gandhi Inst Med Sci 2014;19:148-50

How to cite this URL:
Vaidya YP, Waghmare JE, Tarnekar AM, Shende MR. Unilateral isolated incompletely duplicated ureter. J Mahatma Gandhi Inst Med Sci [serial online] 2014 [cited 2020 Jul 5];19:148-50. Available from: http://www.jmgims.co.in/text.asp?2014/19/2/148/138442


  Introduction Top


Duplication of the ureter is the most common anomaly of the urinary tract. The occurrence of incomplete duplication is three times more common than complete duplication, with a frequency of one in 500 individuals. [1] Incomplete duplication of the ureter is known as a bifid ureter. A duplicated ureter is commonly found in association with other congenital anomalies and defects, such as, anomalies of kidney, urinary bladder, and renal vessels, [2] or other systemic anomalies, such as, hearing loss and anomalies of the external ear. [3] The present case report describes a rare case of an isolated duplicated ureter with a normal kidney, urinary bladder, and renal vessels, in a middle-aged male cadaver.


  Case Report Top


In a routine undergraduate dissection of an approximately 43-year-old male cadaver, a rare case of a unilateral, incompletely duplicated ureter was detected on the left side [Figure 1]. There was no other associated anomaly related to any other system. On the right side the ureter was seen in continuation of a single renal pelvis, as usual, and there was no abnormality in its further course, relation or termination. The renal hilum was located as usual in the transpyloric plane.
Figure 1: (a) Right side image: Upper two arrows denote point of origin from the hilum, lower arrow denotes point of joining of the two limbs of the ureter (b) Left side image shows the sketch diagram of the right side image

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On the left side there were two separate renal pelves, one above the other, each giving rise to a ureter. The relationship of both the pelves was maintained with the renal vein and artery as the sequence vein, artery and pelvis in before backward direction. The duplicated ureters were running parallel to each other, with the laterally placed ureter starting from the pelvis located below and the medially placed ureter starting from the pelvis located above. Both segments of left ureter were crossed by the left testicular vessels. The diameter of both the ureters was almost equal. The two segments descended separately in the abdomen in their entire course and after entering the pelvis they joined as a single ureter at about a distance of 5 cm from the urinary bladder. The opening of the ureter into the bladder did not show any abnormality. Examination of the other thoracic, abdominal, and pelvic viscera and other structures revealed no other gross morphological abnormality.


  Discussion Top


An incompletely duplicated ureter has been detected in the past in association with various congenital anomalies and defects. Various reports are available on duplicated ureters, such as, an associated feature in the Goltz syndrome, [4] high cephalad kidney, duplication of the pelvis, [5] ectopic ureter and contralateral quadrufid ureter, and L3 hemivertebra. [6] Bifid ureter has also been reported in association with complete duplication of contralateral ureter. [7] Chou et al.,[2] have found the coexistence of bilateral retrocaval ureters and duplicated inferior renal cavae. It may be associated with hearing loss and external ear anomalies. [1]

Thus, most of the reports point to a coexistence of the associated renal or systemic anomalies in cases of duplicated ureters. However Das et al. [8] reported an isolated case of an incompletely duplicated ureter, without any other congenital anomaly, in an adult female cadaver. Their description of the case is similar to ours.

An incompletely duplicated ureter may produce complications like ureteroureteral reflux and obstruction of the ureteropelvic junction at the lower pole of the kidney. It may further produce urinary tract infection and hydronephrosis. [1] Nephrolithiasis is also common in persons with an incompletely duplicated ureter. [9] Kao et al. [10] had reported ureteral cancer in a duplicated ureter. However, a bifid ureter may remain asymptomatic in life and create academic interest only. [8] Privett et al. [11] reported no increase in renal diseases in subjects with renal duplication. Transplantation of kidneys with duplicated ureters is also found to be safe. [12] In the present case history of the cadaver, no record of any renal complication was found, however, the possibility of an unrecorded renal complication cannot be ruled out.

Literature suggests that the occurrence of an incompletely duplicated ureter is more common in females and that too on the right side, which is contradictory to the present case. [8]

Developmental basis

During organogenesis, ureteric buds arise from the mesonephric ducts close to their entrance in the cloaca. First, the ureteric buds induce the metanephric blastema to form kidneys and second they divide dichotomously and simultaneously push the metanephros up. Successive divisions of the bud give rise to the ureter, renal pelvis, major and minor calyces, and approximately one to three million collecting tubules. [13] Thus, most of the collecting part of the urinary system is derived from the ureteric bud. However, sometimes the ureteric bud may divide before penetrating the metanephric tissue, thus giving rise to a bifid ureter, with a single opening in the bladder.


  Conclusion Top


Incomplete duplication of the ureter is a common anomaly of the urinary tract. It usually reveals itself due to the complications the subject gets and by attempts made at investigation. These complications may frequently need surgical interventions too. However, individuals with bifid ureters may remain asymptomatic throughout their lives. In the present case history of a 43-year-old male subject, no record of any renal complication was found. However, the patient may have suffered with a renal complication in the past, which may not have been recorded, and also the complications in his later life may not be denied.

 
  References Top

1.Fernbach SK, Feinstein KA, Spence K, Lindstorm CA. Ureteral duplication and its complications. Radiographics 1997;17:109-27.  Back to cited text no. 1
    
2.Chou CT, Yang AD, Hong YC, Wu HK. Bilateral retrocaval ureters with IVC duplication. Abdom Imaging 2006;31:596-7.  Back to cited text no. 2
    
3.Fraser FC, Ayme S, Halal F, Sproule J. Autosomal dominant duplication of the renal collecting system, hearing loss, and external ear anomalies: A new syndrome? Am J Med Genet 1983;14:473-8.  Back to cited text no. 3
    
4.Gunduz K, GunalpI, ErdenI. Focal dermal hypoplasia (Goltz's syndrome). Ophthalmic Genet 1997;18:143-9.  Back to cited text no. 4
    
5.Al Attia HM. Cephalad Renal Ectopia duplication of pelvicalyceal system and patent ductusarteriosus in an adult female. Scand J Urol Nephrol 1999;33:257-9.  Back to cited text no. 5
[PUBMED]    
6.Bhandarkar AD, Raju AM, Rao MS. Single unilateral ectopic bifid ureter with contralateral orthotopicquadrufid ureter - a rare combination. J Postgrad Med 1997;43:104-5.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Tundidor Bermúdez AM. A bifid ureter with a blind branch. Arch Esp Urolo 1999;52:790-2.  Back to cited text no. 7
    
8.Das S, Dhar P, Mehra RD. Unilateral Isolated Bifid Ureter - A Case Report. J Anniston India 2001;50:43-44.  Back to cited text no. 8
    
9.Peres LA, Ferreira JR, Beppu AP, de Araújo Junior ER, Vicenzi G, Yamamoto RY. Anatomical alterations in patients with nephrolithiasis. J Bras Nefrol 2010;32:33-6.   Back to cited text no. 9
    
10.Kao JL, Huang CH, Chang YM, Tsai SC, Yang CL, Shiao CC. Ureteral cancer in a duplicated ureter. QJM 2013;106:777-8.  Back to cited text no. 10
    
11.Privett JT, Jeans WD, Roylance J. The incidence and importance of renal duplication. Clin Radiol 1976;27:521-30.  Back to cited text no. 11
[PUBMED]    
12.Heidari M, Gharaati MR, Iran-Pour E, Simforoosh N, Zare S, Basiri A. Transplantation of kidneys with duplicated ureters. Scand J Urol Nephrol 2010;44:337-40.  Back to cited text no. 12
    
13.Sadler TW. Urogenital system. In: Lanhman's Medical embryology, editor. 11 th ed. New Delhi: Lippincort William and Wilkins Publisher; 2010. p. 235-63.  Back to cited text no. 13
    


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Discussion
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