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LETTER TO THE EDITOR
Year : 2018  |  Volume : 29  |  Issue : 3  |  Page : 166-167

Bilateral complete ureteral duplication with bilateral ureteral calculi


Department of Urology, Chirayu Hospital, Ratnagiri, Maharashtra, India

Date of Web Publication27-Jun-2018

Correspondence Address:
Sunil S Gogate
Amrutwel, Balkrishna Nagar, Nachane Road, Ratnagiri - 415 639, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/UROS.UROS_1_17

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  Abstract 

A 35-year-old female came with right renal colic. Ultrasonography showed left hydroureteronephrosis. Intravenous urography showed bilateral complete duplication with the right upper moiety ureteric calculus and left lower moiety ureteric calculus. Both were treated with rigid ureterorenoscopy. This is first such presentation in the world. Only two cases of complete duplication with urolithiasis, but different presentation are reported so far.

Keywords: Calculus, ureteric duplication, ureteroscopy


How to cite this article:
Gogate SS, Gogate BS. Bilateral complete ureteral duplication with bilateral ureteral calculi. Urol Sci 2018;29:166-7

How to cite this URL:
Gogate SS, Gogate BS. Bilateral complete ureteral duplication with bilateral ureteral calculi. Urol Sci [serial online] 2018 [cited 2018 Oct 20];29:166-7. Available from: http://www.e-urol-sci.com/text.asp?2018/29/3/166/233158


  Case Report Top


A 35-year-old female came with right renal colic for 7 days followed by left renal colic for 1 day and decreased urine output. She had hematuria and nausea also. On examination, her vitals were stable and there was left flank tenderness. Her serum creatinine was 1.3 mg% and hemogram was normal. Ultrasonography showed left hydroureteronephrosis with 10-mm ureteric calculus. Intravenous urography showed bilateral complete duplication with right upper moiety ureteric calculus and doubtful left lower moiety ureteric calculus just below sacroiliac joint [Figure 1].
Figure 1: Preoperative intravenous urography

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Bilateral ureteroscopy was done. Left-sided calculus was in lower moiety ureter with ureteric orifice lateral to normal position of upper moiety orifice. Right upper moiety ureteric orifice was ectopic at the bladder neck, and this ureter contained calculus. Both calculi were cleared with pneumatic lithotripsy. Postoperative computed tomography (CT) urography was normal [Figure 2].
Figure 2: Follow-up computed tomography urography

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  Discussion Top


The patient presented with classic bilateral renal colics. Her preoperative ultrasonography was confusing, but intravenous urography helped diagnosis of bilateral duplication and bilateral ureteric calculi. The ureteric orifice of right upper moiety was ectopic, but both side ureters obeyed Weigert–Meyer Law. The ureteroscopy was not difficult in this case once stone-bearing ureters were identified.

The incidence of duplication anomaly is 0.8% and unilateral duplication occurs six times more than bilateral. This patient had calculi in the left lower and right upper ureters simultaneously. There are cases reported in the literature with duplication of ureter with calculi.[1] However, this type of presentation has never been reported in the literature. Only two cases of complete duplication with urolithiasis, but different presentation are reported so far.[2],[3]


  Conclusion Top


Bilateral ureteric duplication though very rare should be kept in mind when a patient presents with bilateral simultaneous ureteric calculi. Preoperative intravenous urography or CT urography is diagnostic and should be done.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bhatia V, Biyani CS. Calculus disease in duplex system – Role of extracorporeal shockwave lithotripsy. Urol Int 1993;50:164-9.  Back to cited text no. 1
    
2.
Alsayyad AJ. Bilateral complete duplication of the ureters, with calculi simultaneously obstructing the four ureters. Urol Ann 2016;8:226-8.  Back to cited text no. 2
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3.
Aiken WD, Johnson PB, Mayhew RG. Bilateral complete ureteral duplication with calculi obstructing both limbs of left double ureter. Int J Surg Case Rep 2015;6C: 23-5.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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