Crossed-fused Renal Ectopia Associated With Inverted-Y Ureteral Duplication, Ectopic Ureter, and Bicornuate Uteruses

Crossed fused renal ectopia: Diagnosis and prognosis as a single-center experience

BACKGROUND

Crossed fused renal ectopia (CFRE) is a rare congenital malformation. Renal bladder ultrasound (RBUS) is a good tool for establishing the diagnosis, however, additional imaging with a voiding cystourethrogram (VCUG) and dimercaptosuccinic acid scan (DMSA) might be required. We assessed the need for postnatal evaluation and the long-term consequences in patients with this diagnosis.

METHODS

A retrospective review of the records of all patients diagnosed with CFRE between 2004 and 2014 was done. We included all patients who underwent postnatal evaluation with RBUS, DMSA and VCUG. Long-term radiological and functional outcomes were assessed.

RESULTS

A total of 29 patients with CFRE were identified. Majority of cases were detected antenatally (79%) and left to right crossed ectopia constituted the majority of cases (65%). RBUS revealed associated hydronephrosis (HN) in 11 patients (38%). DMSA scans confirmed the diagnosis in all patients and showed impaired renal function in 10 ectopic kidneys (34%). Vesicoureteral reflux was detected in 12 patients (41%); one third of them needed surgical intervention. Extra-urinary anomalies were present in 14 patients (48%) mainly of cardiac origin. After a mean follow-up of 4.5 years, 4 patients (14%) with extra-urinary anomalies developed chronic kidney disease and two of them died.

CONCLUSIONS

Crossed fused renal ectopia is commonly associated with both urinary and extraurinary malformations. Postnatal RBUS is usually sufficient for diagnosis, however, additional imaging may aid for confirming the diagnosis and detection of associated urinary anomalies. Presence of extra-urinary malformations with crossed fused ectopia carries a higher risk of morbidity.

TYPE OF THE STUDY

Retrospective study [diagnostic/prognostic study].

LEVEL OF EVIDENCE

Level IV.

Crossed-fused renal ectopia with renal calculi: Two case reports and a review of the literature

RATIONALE

Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date.

PATIENT CONCERNS

Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day.

DIAGNOSES

On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys.

INTERVENTIONS

Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief.

OUTCOMES

Two patients have been followed up and have no stones recurrence.

LESSONS

Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.

Intermittent Urinary Incontinence Secondary to Inverted-Y Ureteral Duplication With Perianal Ectopia

Inverted-Y ureteral duplication is one of the rarest anomalies of ureteral branching, which has been found to be more prevalent in females.² Females commonly present with urinary incontinence often associated with distal limb ectopia to the bladder neck, uterus, or vagina.² We present the case of a 7-year-old female with intermittent urinary incontinence who was found to have an inverted-Y ureteral duplication with perianal ectopia. We highlight the role of magnetic resonance urography in the evaluation of females with urinary incontinence and a normal renal/bladder ultrasound who are refractory to behavioral therapy.

Duplicated Collecting System with Ectopic Vaginal Implantation

We present a case of a 54-year-old woman with a left-sided complete duplication of the ureter. The upper moiety drains in the proximal third of the vagina, which results in an ureterocele and urinary incontinence. The ureteral orifice of lower moiety ureter was normal. Duplication of the ureters with distal, infra-sphincteric, vaginal implantation is an uncommon congenital anomaly and a rarely seen entity in adulthood as a cause of urinary incontinence. MR colpocystodefecography showed an ureterocele in between the bladder and the rectum. Computed-tomography showed the duplicated ureters and ectopic ureter with proximal implantation on the renal upper pole and distal implantation on the proximal third of the vagina.

Unusual variant of inverted Y ureteral duplication with an ipsilateral seminal vesicle cyst and renal dysgenesis

Inverted Y malformation is a rare variant of ureteral duplication with a marked female predominance. We describe a case of inverted Y ureteral duplication with concurrent ectopic ureteral insertion into a seminal vesicle cyst, a ureterocoele and renal dysgenesis, which occurred in a 29-year-old man with lower urinary tract symptoms, haematospermia and postcoital discomfort. To our knowledge, this is the first reported case with this constellation of urogenital abnormalities.

Diagnosis of rare association of orthotopic multicystic dysplasia with crossed fused renal ectopia

Orthotopic multicystic dysplastic kidney with crossed fused ectopia is a rare congenital anomaly. This congenital anomaly may give an appearance of a solitary kidney morphology during the initial imaging evaluation. A solitary kidney should be carefully evaluated for the presence of duplication, horseshoe configuration, or crossed renal ectopy. Vesicoureteral reflux is a common finding associated with a multicystic dysplastic kidney. We present an infant with an orthotopic multicystic dysplastic kidney and an inferiorly placed crossed fused ectopic kidney. The presence of a complex congenital anomaly may warrant further evaluation with cross-sectional imaging to depict the anatomy and structure.

Y-type partial duplication of a vaginal ectopic ureter with ipsilateral hypoplastic pelvic kidney and bicornuate uterus

We present a case of vaginal ectopic ureter with ipsilateral partial duplication of the upper ureter (Y-type ureter), ipsilateral hypoplastic pelvic kidney and bicornuate uterus in a 20-year-old woman who presented with mild urinary incontinence since infancy. Ultrasonography, computed tomography and intravenous pyelography examination showed a left kidney with no evidence of a right kidney. Cystourethroscopy showed absence of the right hemitrigone. Magnetic resonance (MR) urography demonstrated the presence of a bicornuate uterus, an ectopic dysplastic right kidney in the pelvic cavity, and a right ureter that terminates in the vaginae fornix. The patient underwent right nephroureterectomy and urinary continence was restored completely. Although congenital malformations of the urinary tract are frequently associated with genital tract abnormalities, to best our knowledge, this is the first report of the coexistence of all of these anomalies in an individual. Our report also highlights the importance of MR urography in the diagnosis of such rare and complex anomalies.

Complex genitourinary duplication affecting neurourologic and urodynamic findings: report of a case and review of the literature

BACKGROUND

Complete duplication of the bladder and urethra is a rare congenital anomaly and usually occurs in association with other organ anomalies. We report a case of complete bladder duplication associated with multiple non-genitourinary anomalies.

CASE

A 10-year-old girl presented with urinary incontinence and recurrent episodes of febrile urinary tract infections. Simultaneous right and left bladder urodynamic study was performed and revealed bilateral decreased bladder compliance associated with hyperreflexia. The patient underwent reconstructive surgery with combination of the 2 bladders and closure of the right incompetent bladder neck.

SUMMARY AND CONCLUSION

Management of bladder duplication is directed towards creating an unobstructed urinary tract, preventing infections, and achieving urinary continence. Neurourologic and urodynamic assessment is of utmost importance especially when concomitant spinal anomaly exists. Furthermore, these patients should be observed lifelong as alteration in bladder function may occur.

L-shaped right-to-left crossed-fused renal ectopia with left dysplastic ureter

Crossed-fused renal ectopia is a relatively rare congenital malformation. Herein, we report a case of L-shaped right- to-left crossed-fused renal ectopia with a left dysplastic ureter in a 5-year-old girl. She underwent a left nephrectomy and the postoperative course was uneventful.