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Dhale A, Pendkar R, Hatwar G, Dharamshi JD, Trivedi Y. Ectopic Ureter Opening in Vagina: A Rare Cause of Nonfunctional Kidney and Urinary Incontinence in a Pediatric Patient. Cureus 2024; 16:e60052. [PMID: 38854205 PMCID: PMC11162755 DOI: 10.7759/cureus.60052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/10/2024] [Indexed: 06/11/2024] Open
Abstract
An ectopic ureter is a condition characterized by a ureter, whether single or duplex, that fails to open in the trigone area of the urinary bladder but instead drains outside of it. This anomaly arises congenitally due to abnormal migration of the ureteric bud during its insertion into the urinary bladder. Here, we present a case involving an ectopic ureter draining into the vagina, with continuous urinary incontinence. We discuss the diagnosis, evaluation, and management of urinary incontinence in a female because of an ectopic ureter. A 9-year-old girl child presented with a continuous urinary leak or incontinence requiring the use of one to two pads per day that progressively became wetter throughout the day. Physical examination revealed a normal urethral meatus and vagina without obvious visible dribbling of urine at the introitus. CT urography showed significant dilation of the right ureter, causing hydroureter and ectopic insertion of the tortuous right ureter near the external urethral orifice at the vaginal vestibule, along with an atrophic right kidney. A DTPA (diethylenetriamine pentaacetate) scan indicated the nonfunctional status of the right kidney. The patient underwent a right nephroureterectomy, leading to a complete resolution of urinary incontinence. Ectopic ureter causing nonfunctional kidney and urinary leak or incontinence is rare. This case emphasizes the importance of a comprehensive diagnostic workup for achieving a better prognosis and initiating early treatment of ectopic ureter.
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Affiliation(s)
- Abhijit Dhale
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ruturaj Pendkar
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ghanshyam Hatwar
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jay D Dharamshi
- Urology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yashasvi Trivedi
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Singh S, Dahal S, Kayastha A, Thapa B, Thapa A. Duplex Collecting System with Ectopic Ureters Opening into Vagina: A Case Report. JNMA J Nepal Med Assoc 2022; 60:204-206. [PMID: 35210645 PMCID: PMC9199998 DOI: 10.31729/jnma.6570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/01/2022] Open
Abstract
Continuous urinary leakage, along with normal deliberate voiding, must suggest diagnosis of ectopic ureter, specifically in girls. Combination of a duplicated collecting system with distal, infra-sphincteric, vaginal insertion of ureter is an uncommon congenital anomaly and rare cause of urinary incontinence. We present a case report of a 7-year-old girl who presented to the urology department with urinary incontinence despite successful toilet training and history of recurrent urinary tract infections. Right duplex collecting system was seen on ultrasound. Magnetic resonance urography revealed a near complete right duplex collecting system with ectopic insertion of ureter into vagina, and aplastic uterus with bilateral normal ovaries suggestive of Mayer-Rokitansky-Kuster-Hauser syndrome. Surgical treatment consisted of "common sheath" reimplantation of ectopic ureters into bladder, with complete resolution of symptoms. This case suggests to us that congenital abnormalities of the genitourinary tract should be considered in case of urinary incontinence and recurrent urinary tract infections.
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Affiliation(s)
- Suraj Singh
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal,Correspondence: Dr Suraj Singh, Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal. , Phone +977-9849978358
| | - Sulochana Dahal
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Anuj Kayastha
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Bijay Thapa
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Anupama Thapa
- Department of Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
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Fonseca RR, Covita A, Mota RL. Ureteral duplication with an heterotopic ureteric implantation: a less common cause of adult urinary incontinence. BMJ Case Rep 2021; 14:14/2/e239572. [PMID: 33637499 PMCID: PMC7919557 DOI: 10.1136/bcr-2020-239572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 25-year-old woman with a history of frequent urinary tract infections and dribbling urinary incontinence since early childhood was referred to our urology clinic. An accurate investigation revealed a complete right ureteral duplication, with a dysplastic upper-pole renal moiety and an ectopic right ureter draining into the vagina. The patient underwent surgical exploration which confirmed the diagnosis. It was also possible to see a communication between renal moieties which allowed for a laparoscopic ligation and excision of the heterotopic right ureter. The patient had a good recovery, with a complete resolution of her complaints and a great improvement of her quality of life.
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Affiliation(s)
- Rita Rodrigues Fonseca
- Urology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal .,Introduction to Clinical Practice, Nova Medical School - Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Covita
- Urology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Renato Lains Mota
- Urology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
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Calle-Toro JS, Maya CL, Emad-Eldin S, Adeb MD, Back SJ, Darge K, Otero HJ. Morphologic and functional evaluation of duplicated renal collecting systems with MR urography: A descriptive analysis. Clin Imaging 2019; 57:69-76. [PMID: 31136881 DOI: 10.1016/j.clinimag.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/24/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe the morphology and function of duplicated collecting systems in pediatric patients undergoing functional MR urography (fMRU). METHODS This is a HIPAA compliant IRB approved retrospective study of all patients with duplicated renal collecting systems undergoing fMRU at our institution between 2010 and 2017. Two pediatric radiologists evaluated the studies to determine the presence, morphology and function of duplicated collecting systems using both T2-weighted and dynamic post-contrast fat saturated T1-weighted images. Assessed morphologic features included pelvic and calyceal dilation, partial or complete ureteral duplication, ureteral dilation, ectopic ureteral insertion and ureteroceles. Functional analysis was carried out per moiety. RESULTS A total of 86 examinations (63 girls; 23 boys), median age 2.6 years (Standard Deviation 6.4 years, interquartile range: 0.4-10.3 years) and 107 kidneys (39 right; 30 left and 19 bilateral), which yielded 214 evaluable moieties, were included in the final sample. One hundred and sixty-three (76.1%) of the moieties had normal morphological features and normal functional results (average calyceal transit time and renal transit time of 2 min 28 s and 3 min 16 s, respectively). The remaining 51 moieties (23.8%) were hypoplastic or dysplastic. Seventy-seven (35.9%) had pelvic and calyceal dilation. Slightly more than half of the kidneys had complete ureteral duplication (60/107; 56%); 50 (50/107, 46.7%) had ectopic ureters (23 intra- and 27 extravesical) and 9 (9/107, 8.4%) had ureteroceles. CONCLUSION fMRU provides comprehensive information regarding the morphology and function of duplicated renal collecting systems in children. In particular, fMRU is useful for assessing barely or non-functioning renal poles and ectopic ureters.
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Affiliation(s)
- Juan S Calle-Toro
- Section of Genitourinary Imaging, Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Children's Hospital of Philadelphia, 3401 Civic Center blvd, Philadelphia, PA 19104, United States of America; Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt
| | - Carolina L Maya
- Section of Genitourinary Imaging, Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Children's Hospital of Philadelphia, 3401 Civic Center blvd, Philadelphia, PA 19104, United States of America; Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt
| | - Sally Emad-Eldin
- Section of Genitourinary Imaging, Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Children's Hospital of Philadelphia, 3401 Civic Center blvd, Philadelphia, PA 19104, United States of America; Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt
| | - Melkamu D Adeb
- Section of Genitourinary Imaging, Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Children's Hospital of Philadelphia, 3401 Civic Center blvd, Philadelphia, PA 19104, United States of America; Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt
| | - Susan J Back
- Section of Genitourinary Imaging, Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Children's Hospital of Philadelphia, 3401 Civic Center blvd, Philadelphia, PA 19104, United States of America; Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt
| | - Kassa Darge
- Section of Genitourinary Imaging, Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Children's Hospital of Philadelphia, 3401 Civic Center blvd, Philadelphia, PA 19104, United States of America; Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt
| | - Hansel J Otero
- Section of Genitourinary Imaging, Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Children's Hospital of Philadelphia, 3401 Civic Center blvd, Philadelphia, PA 19104, United States of America; Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt.
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Al Ghafri A, Fida A, Al-Gharras A. Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome. Oman Med J 2018; 33:69-71. [PMID: 29468003 DOI: 10.5001/omj.2018.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare congenital abnormality of the female urogenital tract. We reported OHVIRA syndrome in a 15-year-old girl, who was referred to King Faisal Specialist Hospital and Research Centre, due to hematocolpos and an imperforate hymen. The patient was diagnosed as having an absent right kidney since childhood. She presented with progressive development of lower abdominal discomfort and an abdominopelvic mass. She had no history of urinary complaints. Here, we describe our findings from the abdominal ultrasound and magnetic resonance imaging.
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Affiliation(s)
- Aziza Al Ghafri
- Radiology Department, Ibri Regional Hospital, Al Dhahira, Oman
| | - Alaeddin Fida
- Radiology Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Gharras
- Radiology Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Tang M, Wang Q, Liu B, Li J, Lu Q, Song N, Wang Z, Zhang W. Single ectopic ureteral orifice with bilateral duplicated renal collecting systems in an adult girl: Diagnosis by magnetic resonance urography. Can Urol Assoc J 2015; 9:E554-8. [PMID: 26609333 DOI: 10.5489/cuaj.2886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Renal duplication accompanied by ureteral ectopia is an uncommon urinary congenital abnormality. We report the case of a 21-year-old girl who suffered from lifelong continuous urinary leakage. She was finally diagnosed with bilateral duplicated collecting systems complicated with right ectopic ureteral orifice - an extremely rare case. The patient underwent ureteric re-implantation for the ectopic side, and her urinary incontinence ceased soon thereafter. In this case, traditional imaging failed to show the exact insertion of an ectopic ureter. However, magnetic resonance urography combined with retrograde intubation radiography successfully depicted the point of ureteric insertion, which may make the diagnostic process accurate and efficient.
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Affiliation(s)
- Min Tang
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Quanrongzi Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bianjiang Liu
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Li
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ninghong Song
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zengjun Wang
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Zhang
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Uterine didelphys associated with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome. Radiol Case Rep 2015; 5:327. [PMID: 27307842 PMCID: PMC4898179 DOI: 10.2484/rcr.v5i1.327] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare complex of structural abnormalities of the female urogenital tract. A 17-year-old girl with uterine didelphys associated with OHVIRA syndrome presented with progressive development of cyclic lower abdominal discomfort and a large abdominopelvic mass. We describe the findings from ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), the first case report of this syndrome to examine all three different imaging modalities in a single patient. We also review the literature on OHVIRA syndrome and discuss important considerations relevant to radiologists and other clinicians.
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8
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Demir M, Çiftçi H, Kılıçarslan N, Gümüş K, Oğur M, Gülüm M, Yeni E. A case of an ectopic ureter with vaginal insertion diagnosed in adulthood. Turk J Urol 2014; 41:53-5. [PMID: 26328201 DOI: 10.5152/tud.2014.81567] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/30/2013] [Indexed: 11/22/2022]
Abstract
Ectopic ureter which is one of the causes of urinary incontinence in adults is a rarely seen entity. In this case, diagnosis and treatment of urinary incontinence in a female patient thought to originate from an ectopic ureter will be evaluated. On magnetic resonance (MR) urograms double collecting system in both kidneys and also grade 3 hydroureteronephrosis in the collecting system which drained the upper pole of the right kidney were seen. The ureter draining the upper pole of the right kidney was seen to open into a 24 mm-wide cystic pouch inside the right lateral wall of the vaginal cuff. During vaginal examination an orifice of 3 mm was observed on the right wall of the vagina. Right ureteroneocystostomy was performed. Ureters with ectopic orifices are very rarely seen causes of urinary incontinence. To establish the diagnosis, this pathology must be recognized, should be kept in mind, and appropriate diagnostic methods must be used.
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Affiliation(s)
- Mehmet Demir
- Department of Urology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Halil Çiftçi
- Department of Urology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Nihat Kılıçarslan
- Department of Radiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Kemal Gümüş
- Department of Urology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Mehmet Oğur
- Department of Urology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Mehmet Gülüm
- Department of Urology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
| | - Ercan Yeni
- Department of Urology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
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Adeb M, Darge K, Dillman JR, Carr M, Epelman M. Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am 2013; 21:717-30. [PMID: 24183522 DOI: 10.1016/j.mric.2013.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Duplex renal collecting systems are common congenital anomalies of the upper urinary tract. In most cases they are incidental findings and not associated with additional pathologies. They demonstrate, however, higher incidences of hydroureteronephrosis, ureteroceles, and ectopic ureters. The most comprehensive morphologic and functional evaluation of duplex systems can be achieved using magnetic resonance urography. Functional magnetic resonance urography allows better separation of the renal poles, thus more accurate calculation of the differential renal functions compared with renal scintigraphy. Magnetic resonance urography is the study of choice when upper urinary tract anatomy is complex or when functional evaluation is needed.
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Affiliation(s)
- Melkamu Adeb
- Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Iwatsuki S, Kojima Y, Imura M, Mizuno K, Kohri K, Hayashi Y. Detection of Ectopic Ureteral Insertion to Vagina With Hypoplastic Ectopic Kidney by Three-Dimensional Computed Tomography. Urology 2009; 73:505-6. [PMID: 19022483 DOI: 10.1016/j.urology.2008.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 09/04/2008] [Accepted: 09/06/2008] [Indexed: 10/21/2022]
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Yu HT, Chao A, Wang CJ, Chao AS, Lai CY, Wang CR, Huang YC. Integrated imaging studies and endoscopic management of purulent vaginal discharge in a 6-year-old: vaginal ectopic ureter associated with ipsilateral dysplastic kidney. Eur J Obstet Gynecol Reprod Biol 2008; 142:160-1. [PMID: 19036493 DOI: 10.1016/j.ejogrb.2008.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 09/09/2008] [Accepted: 10/03/2008] [Indexed: 11/24/2022]
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12
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Current World Literature. Curr Opin Obstet Gynecol 2007; 19:596-605. [DOI: 10.1097/gco.0b013e3282f37e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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