Unilateral duplicated collecting system and ureter with severe hydroureteronephrosis and ectopic ureter insertion of...

Incidence of duplicated urinary system is 0.7-4% of population, mostly are females and often diagnosed in childhood. Various symptoms meet difficulties to be diagnosed.

A 20-years-old woman admitted to hospital with fever, fatigue, nausea, loss of appetite, colic epigastric pain and right flank pain since 5 days before admission, normal pattern of urination with dribbling and recurrent urinary tract infection. Abdominal ultrasonography showed complicated cystic tumor upper pole of right kidney. Abdominal computed tomography with contrast showed enlargement right kidney with duplicated collecting system and duplicated ureter obstruction (severe hydroureteronephrosis right upper pole moiety) right kidney and ectopic ureter insertion of upper pole moiety between urethra and anterior vagina, no insertion to bladder, seemed to be dead end.

Various symptoms of duplicated collecting system are asymptomatic, flank pain, abdominal pain, urinary incontinence, and recurrent UTI, often accompanied by abnormality of upper pole or lower pole or both. Abnormality of upper renal moiety usually has ectopic ureter as in Weigert-Meyer principle. Insertion into infrasphincter usually manifests as urinary dribbling or urinary incontinence or normal urination with few volume leakage or spotting incontinence, whereas suprasphincter usually manifests as recurrent UTI without incontinence. There are imaging modalities for diagnosing these anomalies, including USG and abdominal CT with contrast.

Understanding embryology, symptoms, imaging modality, and complications are necessary to consider this diagnosis for early detection. Ultrasonography and abdominal CT with contrast can be used to diagnose the urinary tract anomalies, especially duplicated urinary systems with ectopic ureter insertion.