[Ureteral triplication--a case report]
Dragana Zivković1, Jan Varga, Slobodan Grebeldinger
1Medicinski fakultet Novi Sad, Institut za zdravstvenu zastitu dece i omladine, Klinika za decju hirurgiju. zdragana@eunet.yu
Insights
Ureteral triplication, a rare congenital anomaly, often presents with recurrent urinary infections. Surgical intervention for this condition, as seen in a pediatric case, can effectively resolve symptoms and prevent further complications.
Area of Science:
- Pediatric Urology
- Congenital Anomalies
- Urogenital Development
Background:
- Urogenital abnormalities affect 30-40% of children with congenital anomalies.
- Urinary tract infections are the most common symptom of asymptomatic urogenital anomalies.
Observation:
- A four-year-old girl presented with recurrent urinary infections and physical findings suggestive of an underlying anomaly.
- Radiological examinations revealed a rare case of right-sided ureteral triplication with severe vesicoureteral reflux.
Findings:
- Intraoperative findings confirmed type III ureteral triplication.
- Surgical correction involving ureteral remodeling and reimplantation was successfully performed.
- Postoperative follow-up demonstrated the absence of vesicoureteral reflux.
Implications:
- Ureteral triplication, though rare, necessitates thorough diagnostic imaging for accurate identification.
- Associated anomalies such as ureteral duplication and kidney dysplasia are common.
- Individualized treatment, whether conservative or surgical, is crucial for managing symptomatic ureteral abnormalities.
Introduction:
Of all children born with congenital anomalies, 30-40% have urogenital abnormalities. Most of them are asymptomatic, but if any symptoms occur, they are usually symptoms of urinary infections.
Case Report:
A four-year old girl was admitted because of recurrent urinary infections and in order to perform a thorough clinical examination. Clinical examination showed an asymmetrical gluteus and presence of a fibroma in the same region. Detailed radiologic examinations (ultrasonography, plain X-ray, excretory urography, voiding urethrocystography) revealed a triplicate ureter on the right side with a vesicoureteral reflux of the fifth grade on the same side. Intraoperatively, type III ureteric triplication according to Smith's classification was established. Ureteral remodeling and reimplantation was done. The postoperative course was good, and follow-up voiding urethrocystography showed absence of reflux.
Discussion:
Ureteral triplication is a consequence of either development of three buds on the mesonephric duct, or development of two buds, one of which further divided into two parts. Most common anomalies associated with ureteral triplication are: ureteral duplication on the other side (37%), ectopy of the ureteric orifice (28%) and kidney dysplasia (8%). Vesicoureteral reflux is very common on affected or on both sides. Symptomatology is the same as in ureteral duplication--dominated by signs of urinary infections.
Conclusion:
Diagnosis of ureteral duplication requires detailed imaging. Treatment of symptomatic abnormalities should be individual, regardless of the applied treatment (conservative or operative).
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