Congenital malformations of the ureter: anatomical studies

Vascular and Urinary Tract Anatomic Variants Relevant to Para-Aortic Lymphadenectomy in Women with Gynecological Cancers

BACKGROUND

Para-aortic lymphadenectomy is an essential part of gynecologic oncologic surgical treatment. The surgeon should be aware of the complex usual anatomy and its common variants.

METHODS

Between January 2021 and May 2023, 58 women underwent para-aortic lymphadenectomy for gynecologic malignancies.

RESULTS

Vascular and urinary tract anatomic variants were retrospectively reviewed from the prospective institutional database and results were compared with preoperative contrast-enhanced abdominal CT. Of these 58 women, 47 women had no vascular or urinary tract variants. One woman had a double inferior vena cava, two patients were found to have a retro-aortic left renal vein, four had accessory renal arteries, two had a double left ureter, one had a ptotic kidney in the iliac fossa, and one patient had bilateral kidney malrotation. Anatomic variants in the preoperative CT were described by a radiologist in only two patients, and additional vascular and urinary tract variants were found incidentally at the time of surgery.

CONCLUSIONS

Acknowledgment of vascular and urinary tract variants is helpful for the surgeon to establish an appropriate surgical plan and to avoid iatrogenic surgical trauma.

Unilateral Duplicated Collecting System Identified During Pelvic Lymphadenectomy: A Case Report and Literature Review

Anatomic variations can be an additional challenge for any surgeon, especially in complicated surgical procedures, and they could lead to complications if not identified timely.

We present a case report of an incidental intraoperative finding of unilateral duplicated ureter, identified during pelvic lymphadenectomy for a patient who underwent surgical treatment for ovarian cancer. Also, we include an update on this anatomic variation following the literature review.

The importance of a systematic approach in the identification of the relevant anatomy and landmarks, taking into consideration the variation of the duplicated ureter, is emphasized in this paper and may contribute beneficially to the experience of surgeons operating in this field.

Double Ureter: Incidence, Types, and Its Applied Significance-A Cadaveric Study

Introduction

Congenital ureter anomalies such as double ureters are uncommon developmental anomalies of the renal system. An abnormal branching pattern of ureteric bud results in the formation of double ureter. This study examined the incidence of double ureter in cadavers of a South Indian population.

Methods

A total of 50 kidney and ureter specimens were carefully dissected out of the posterior abdominal wall and examined for the presence and subtype of double ureter.

Results

Of 50 kidneys, three (6%) specimens showed an incomplete double ureter, two on the right kidney and one on the left. In all three specimens, the double ureter fused at different levels to form a single ureter opening into the bladder. 

Conclusions

The prevalence of incomplete double ureter is higher in this study compared with that in previous cadaveric studies. Ureteral injuries are a frequent complication of abdominal and pelvic surgeries. Hence, awareness about the types and varieties of double ureter will aid radiologists and surgeons in interpreting and diagnosing urological images and preventing accidental injury while performing surgery.

Acute pyelonephritis revealing an intraprostatic obstructive megaureter in an adult: A rare finding

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Duplicated renal collecting system is one of the most common congenital upper urinary tract abnormalities.

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Estimated prevalence ranges between 0.3–6% in the general population.

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Duplex system with ectopic obstructive megaureter in the prostatic urethra is rare and exceptionally revealed in adulthood.

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Although considered an anatomical variant, duplex collecting system may be complicated by vesicoureteral reflux, ureterocele, or ectopic ureter.

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In case of complicated duplex collecting, the surgical treatment may include upper pole nephrectomy or total nephrectomy. For pediatric patients, nephron-saving surgery is recommended.

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Early diagnosis and treatment of complicated duplex system is important.

Introduction

Duplicated renal collecting system is one of the most common congenital upper urinary tract abnormalities. Duplex system with ectopic obstructive megaureter in the prostatic urethra is rare and exceptionally revealed in adulthood.

Presentation of case

We present a rare case of a 72-year-old man without any previous history of urinary symptoms, admitted through the emergency department for altered general condition associated with fever for several days. Investigations have identified left complete duplex system and intraprostatic obstructive megaureter manifesting as acute pyelonephritis. The evolution of acute pyelonephritis was favorable under urine drainage by percutaneous nephrostomy tube and antibiotherapy.

Given the multiple comorbidities of the patient, radical surgical treatment by left upper pole nephrectomy was ruled out and we opted for an iterative change of percutaneous nephrostomy tube.

Discussion

We briefly review the pathophysiology, diagnosis and therapeutic aspects.

Conclusion

Early diagnosis and treatment of complicated duplex system is important. Urologists should keep this anomaly in mind.

Duplex System with Ectopic Ureter Opens into the Posterior Urethra: Case Report

Introduction

Duplicated ureter or Duplex Collecting System is a congenital condition in which the ureteric bud, the embryological origin of the ureter, arises twice, resulting in two ureters draining a single kidney. This congenital anomaly is rare, and even rarer when the duplex system with ectopic ureter is present. This type of congenital anomaly is even more rarely diagnosed and surgically treated in adulthood.

Case report

This case report presents a case of a 32-year-old male, who had a duplex collecting system with two ureters on the left side. Ectopic ureter, draining the upper pole of the left kidney, opened into the posterior urethra. In our patient, taking into account the clinical perspective, the renal tissue damaging of the upper pole which was not functional, partial nephrectomy and ureterectomy was successfully performed.