Distal blind-ending branch of a bifid ureter

Ureteral duplication is a common congenital anomaly of the urinary system observed in 0.8% of autopsy series [1]. However, bifid ureter with a blind branch is a rare condition. It is three times more prevalent in women than men and is observed twice as often on the right side as on the left side [2]. It does not generally give any clinical symptoms. However, in the literature, symptomatic cases with haematuria, flank pain, urinary infection, stone, vesicoureteral reflux and abdominal mass have been reported [3, 4]. We report a case on which ureteroscopy was performed to the right ureteral duplication with a blind-ending branch and left distal-end ureteral stone. A 40-year-old woman was admitted to our clinic with acute left renal colic, dysuria and frequency micturition. She had no previous history of urinary tract symptoms. Laboratory tests showed normal renal function. Urine analysis and culture showed haematuria without infection. In the direct urinary system graphy (DUSG) and ultrasonography (US) a left distal ureteral stone was detected; hence excretory urography (EU) was also performed on the patient. The EU showed a distal ureteral stone on the left side and two radio-opaque shadows in the region of the distal right ureter (Figures 1, 2). Surgery for the ureter stone and diagnostic ureteroscopy (DU) on the ureter with anomaly were planned to be performed in the same session. Ureteroscopic stone removal was performed on the left sided distal ureteral stone. In same session, DU was performed and distal blind-ending branch of bifid ureter 7 cm long was confirmed at the position 5 cm from the beginning of the ureterovesical junction (Figure 3). No pathology was determined in the lumen of the blind-ending branch. The images were recorded on DU. The patient was discharged from the hospital the day following the operation. Since no complication related to ureter anomaly developed in the post-operative follow-up, blind-ending ureter was not intervened. Blind-ending bifid ureter is a rare congenital anomaly of the ureter which has three sub-types according to the localization. These are proximal, distal, and middle according to their frequencies [2]. Our case was a distal blind-ending ureter, which is less frequent than the proximal and more frequent than the middle blind-ending bifid ureter. Many blind-ending ureters are clinically insignificant and do not give any symptoms because of this. Patients who develop symptoms generally have complaints about abdominal pain, dysuria, frequency micturition, and haematuria. These complaints might depend on stone formation, vesiCorresponding author: Dr. Alper Dilli Department of Radiology DIskapI Yildirim Beyazit Training and Research Hospital Ministry of Health 06110 DIskapI/Ankara Turkey Phone: +905304653941 E-mail: [email protected] Letter to the editor