Duplex Collecting System with Ectopic Ureters Opening into Vagina: A Case Report

Ectopic Ureter: Spectrum of Magnetic Resonance Imaging Findings

OBJECTIVE

This study aims to describe the MRI findings of six patients with ectopic ureters in a tertiary care institute.

METHODS

A retrospective analysis was conducted on six patients presenting to the Department of Radiodiagnosis at Sawai Man Singh (SMS) Hospital, Jaipur, India, with ectopic ureters. Data were collected from the 3 Tesla (3T) Philips MRI scanner (Koninklijke Philips N.V., Amsterdam, Netherlands) from 2021 to 2023.

RESULTS

The mean age was 21.6 years, with an equal male-to-female ratio (1:1). Most patients presented with urinary incontinence (50%, n = 3), followed by abdominal pain. Only 16.6% (n = 1) were associated with a duplex collecting system. In males, the most common site was the seminal vesicle, observed in 66.6% (n = 2), followed by the urethra in 33.4% (n = 1) of cases. One patient with an ectopic opening into the seminal vesicle had Zinner syndrome. In females, the ectopic site was found to be the vagina in all three patients.

CONCLUSION

Ectopic ureter is a rare anomaly of the urinary system, often associated with other urinary system anomalies and a few syndromes. Clinical presentations range from the patient being asymptomatic to renal failure; therefore, a high index of suspicion and appropriate imaging are necessary for early diagnosis and timely treatment.

An Unusual Presentation of a Rare Combination of Double Moiety and Vaginal Ureter Insertion

The association between a duplex renal collecting system and ectopic ureter insertion is well-established. Although congenital genitourinary abnormalities are usually detected during childhood, incidentally, or due to underlying symptoms or medical complications, a few cases might not be diagnosed/treated until adulthood. Herein, we present a case of a 43-year-old lady who came to the emergency department with acute left flank pain associated with a burning sensation during micturition for four days. Imaging showed a duplex collecting system, and findings suggestive of obstructive uropathy. The patient underwent an initial trial of left ureteroscopy that was unsuccessful. Therefore, the interventional radiology (IR) department was consulted to perform left percutaneous nephrostomy insertion with antegrade ureteric stenting, where the patient was noted to have ectopic ureter insertion into the anterior wall of the vagina by antegrade ureterogram. The patient underwent ureter re-implantation to save the kidney from further insult.