Dirk Schaper, P. Göbel (Kinderchirurgie St. Barbara-Krankenhaus Halle/S.)  

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5 Years  

Male  

Pelvis-Urinary bladder  

congenital  

5 year-old boy without clinical complaints. Incidental findings on sonogram (Ultrasound 1) in the course of treatment for balanitis. Right-sided duplicated urinary tract system without urinary obstruction. Left: unremarkable kidney.  

N/A  

<- view Ultrasound 1

Ultrasound 1: Abdomen axial, bladder with an unclear, echogenic structure to the left in the trigonal region.




<- view X-Ray 1

X-Ray 1: Voiding cystourethrogram (VCUG) ap, left-sided vesico-ureteral-reflux (VUR) III°







<- view X-Ray 2

X-Ray 2: Voiding cystourethrogram (VCUG) oblique view, during urination. Bulging of the bladder dorsolaterally with oblique VUR III° on the left side, The left pelvicocaliceal system resembles a wilting flower .






<- view X-Ray 3

X-Ray 3: Voiding cystourethrogram (VCUG): further enlargening of the structure during micturition.






<- view Ultrasound 2

Ultrasound 2: Abdomen axial, anechoic structure on the left side, changing in size during the exam, no depiction of the ureter.




<- view Ultrasound 3

Ultrasound 3: Lower abdomen axial: Again demonstrated is the anechoic strcuture on the left, which is changing in size during the continuous examination. When the bladder contracts, enlargening.




<- view Ultrasound 4

Ultrasound 4: Sonogram during urination, an obvious enlargening of the pathology




<- view Ultrasound 5

Ultrasound 5: Bladder continues emptying, pathology becomes larger.




<- view Ultrasound 6

Ultrasound 6: Bladder is empty, pathology further enlarged.




<- view OP-Situs 1

OP-Situs 1: Intraoperative findings



 

Surgery / Histo  

Ureterocele, parostial diverticlum, megaureter  

Since the sonographic image was initally unclear, a cystoscopy was performed. This showed a widened ostium in a prominent mucous membrane without signs of the diverticulum's entry side and without proof of a second ostium. In the VCUG, reflux to the lower pole moiety was demonstrated. The left pelvicocaliceal system resembled a wilting flower which allows the suspicion of a duplicated renal system.


In the MAG3 scintigraphy, the functioning part of the left kidney was measured as 25.5%. No proof of an upper moiety.

This resulted in an operation to resect the diverticulum and to replant the ureter. Intraoperatively, a second, hypoplastic ureter is seen, which does not show urine flow and is not able to be probed. The diverticulum is large, the ureter of the lower moiety connects inserts into the central portion of the diverticulum. The connection with the second ureter could not be seen. A resection of the diverticulum and the neoimplantation of the ureter into the lower moiety was performed. The hypoplastic ureter has been resected.  

The overall pathology is difficult to interpret. Is this a bladder diverticulum, in which both ureters join, or is this a protruded ureterocele? Because of the intraoperative situation and the obvious hypoplasia of the upper pole moiety uereter, it seems rather unlikely that this is a protruded ureterocele. Furthermore, a histological examination does not describe a ureterocele.

In the follow-up examination and after the ureter was re-implanted, the left kidney is not dilated. An upper pole moiety is still not able to be demonstrated.
 

N/A  

1. Medline:
Minevich E, Moayed A, Wacksman J, Lewis AG, Sheldon CA.
Unusual anatomic presentation of ectopic ureteroceles
J Pediatr Surg. 1999 Mar; 34(3): 474-6

2. Medline:
Bellah RD, Long FR, Canning DA
Ureterocele eversion with vesicoureteral reflux in duplex kidneys: findings at voiding cystourethrography
AJR Am J Roentgenol. 1995 Aug; 165(2): 409-13

3. Medline:
Beasley SW, Kelly JH
Inverted Y duplication of the ureter in association with ureterocele and bladder diverticulum
J Urol. 1986 Oct; 136(4): 899-900  

duplicated kidney, duplicated collecting system, double kidney, bladder diverticulum, double, kidney, bladder, diverticulum, duplication, duplication of renal collecting system, renal duplication, ureteral duplication, ureter duplication, child, childhood, pediatric radiology  

Dirk Schaper, P Göbel. Bladder Diverticulum with Double Kidneys and Duplicated Ureter. PedRad [serial online] vol 4, no. 1.
URL: www.PedRad.info/?search=20040123095758