A Unique Case of Incomplete Bifid Ureter and Associated Arterial Variations

Introduction. Urogenital and vascular anomalies, including a left duplex kidney and a left aberrant renal artery that gave rise to the left ovarian artery, were observed in a 77-year-old female cadaver during a routine dissection. Description. A left aberrant renal artery, which gave rise to the left ovarian artery, was observed originating from the aorta 4 cm below the left renal artery. Two independent contributions to a bifid ureter were found originating from the hilum of the left kidney. These two contributions descended 12.4 cm and 10.6 cm, respectively, posterior to the left aberrant renal artery and lateral to the left ovarian artery before uniting anterior to the psoas major muscle to descend 12.7 cm to the bladder. Significance. While the duplex kidney is a relatively common congenital anomaly that can be asymptomatic, it can also potentially be associated with compression of renal vasculature or the ureter. Ureteral compression can then result in several pathologies including reflux, urinary tract infection (UTI), ureteropelvic junction obstruction, or hydronephrosis. Compression of renal and ovarian vasculature can result in altered blood flow to the kidney and ovary, potentially causing fibrosis, atrophy, or organ failure. Current imaging techniques alone are insufficient for correct diagnostics of such complications, and they must be supplemented with a thorough understanding of the respective anatomical variations.

A Rare Case of Ureteral Diverticulum Incidentally Detected During Angiography

Background: A ureteral diverticulum (UD) is a rare urological malformation characterized by the saccular enlargement of the ureteral wall. It can be of different sizes and in various localizations. In the literature, three types of UD have been defined as abortive bifid ureter, congenital, and acquired. Case Report: In a 65-year-old male patient, an enlargement was incidentally detected in the distal part of the right ureter on fluoroscopy during the passage of the contrast agent applied during angiography. The medical history of the patient was not remarkable; thus, computed tomography (CT) was performed to investigate the etiology. A dilated tubular structure separate from the ureter was observed in the middle part of the right ureter on CT, clearer in the excision phase. This tubular structure distally connected with ureter and was consistent with the abortive bifid ureter type of UD. Discussion: UD may present with renal colic, hematuria, and upper urinary tract infections, or it may be asymptomatic as in our case. Asymptomatic cases are usually incidentally detected during radiological imaging. Although treatment is not required for these patients, surgical treatment may be required in the presence of symptoms. Conclusion: UD is an entity that can be asymptomatic until adulthood and may be detected incidentally in radiological evaluations. UD should be kept in mind when the cystic lesion associated with the ureter is detected in radiological examination. Excretory phase CT / CT urography noninvasive imaging method must be preferred in to evaluate the relationship of the lesion with the ureter.

Feasibility of a single session retrograde endoscopic laser lithotripsy of two large stones located in a bifid urinary tract. Presentation of a rare case

A 76 year-old male presented with urosepsis and acute renal injury secondary to obstruction by a 13 mm stone located in the common segment of a bifid left ureter. A second 10 mm stone was detected in the mid calyx of the lower moiety of the kidney. Drainage of both moieties with two double-J stents was initially performed. Following recovery from urosepsis a retrograde endoscopic semirigid and flexible laser lithotripsy of the distal and proximal stone respectively was performed resulting in stone clearance. Although retrograde ureterolithotripsy has been presented in the past, to the best of the authors’ knowledge, this is the first description of flexible retrograde intrarenal lithotripsy performed through a bifid ureter.