Symptomatic ureteric triplex in a child.

Area of Science:

• Pediatric Urology
• Medical Imaging
• Surgical Case Reports

Background:

• Urinary tract infections (UTIs) are common in children and can be associated with congenital anomalies.
• Vesicoureteric reflux (VUR) and ureteroceles are known risk factors for recurrent UTIs.
• Complex renal anomalies, such as duplex or triplex systems, can present diagnostic challenges.

Observation:

• A 4-year-old girl presented with symptomatic, culture-proven urinary tract infections.
• The underlying cause was a triplex system associated with a ureterocele and vesicoureteric reflux.
• This anomaly was incidentally discovered during a planned left heminephrectomy, as it was not detected by prior ultrasound or micturating cystourethrogram.

Findings:

• The triplex system, ureterocele, and associated vesicoureteric reflux were surgically addressed by removing the redundant system.
• Post-operatively, the patient became asymptomatic, with resolution of the recurrent UTIs.

Implications:

• This case underscores the potential for complex urinary tract anomalies to be missed by standard preoperative imaging.
• Early and accurate diagnosis of congenital renal anomalies is crucial for effective management of recurrent UTIs in children.
• Surgical intervention for complex systems can lead to complete symptom resolution and improved patient outcomes.