Bilateral Duplicated Renal Collecting Systems and Associated Pathology: An Unusual Case Report

A 31-year-old female with a 19 year history of chronic urinary tract infections (UTI), intermittent hematuria, and associated flank pain was referred to our service for evaluation of anatomy of renal system and possible surgical intervention. At the time of the referral, the UTI’s had become more frequent and the flank pain had increased in severity.The following diagnostic studies were employed to elucidate the etiology of the patient’s condition:abdominal and pelvic computed tomography (CT) scans, intravenous pyelogram (IVP), voiding cystourethrogram (VCUG), kidney ureter and bladder x-rays (KUB), flexible cystoscopy, bilateral renal ultrasounds (RUS), cystourethroscopy with sounding, bilateral retrograde pyelograms with fluoroscopy, and ureteroscopy. Our studies revealed an uncommon, bilateral duplication of the urinary collecting systems. Upper and lower pole collecting systems, each with their own ureter, were discovered for both kidneys. Chronic changes of the upper pole collecting system of the left kidney including hydroureter, caliectasis, and renal calculi were also observed. Furthermore, a large ureterocele, measuring 4 cm in length x 2 cm maximumtransverse diameter, was observed in the distal portion of the left upper pole collecting system ureter. This ureter inserted into the proximal band of the urinary sphincter. These findings are consistent with an obstructive process that resulted in chronic damage to the left upper pole collecting system, and presents a difficult clinical scenario to manage. The duplicated collecting system on the right showed normal function despite its anatomical variation. Based on this finding, we believe that the location where the duplicated ureter inserts into the bladder is more predictive of chronic renal insult and associated pathology versus the presence of the variant alone causing problems.