A Complete Duplicated Collecting System with Giant Ureteroce
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A 25-year-old female patient was referred with a suspicious right renal cyst and uterine cyst through ultrasonography findings. There was a history of minor recurrent right flank pain for the last five months and no urinary flow symptoms. Physical examinations were within normal limits, with a soft, non-painful, and depressible abdomen, non-painful and non-distended right flank region, and no mass nor other abnormality in external genitalia. The patient did have a medical report at the age of 2 years old when she had a mass that burst out from her urethra. She was examined in a hospital, performed urethral catheterization, and removed the catheter a week later.

Abdominal ultrasonography showed right upper pole hydronephrosis grade III-IV and right proximal-distal hydroureter. Intravenous pyelography showed a 'drooping lily' sign in the right urinary system. Computerized tomography (CT) urography with contrast confirmed right upper pole hydronephrosis grade III-IV, right proximal-distal hydroureter, and a giant ureterocele in the neck of the bladder. The left pelvicalyceal system and ureter were visualized normally.
The patient underwent a cystoscopy performed by the main author in a general hospital. The Cystoscopic examination found the ureterocele had filled the bladder neck area and identified upper pole ureteral insertion in posterior urethra, normal lower pole ureteral insertion, and no decompensated bladder. Unfortunately, no Isotope renal scintigraphy scan was performed due to under maintenance. In this case, the differential diagnosis was a duplication of the right collecting system associated with double ureters, hydroureteronephrosis in the upper pole, and ureteral ectopia with giant extravesical ureterocele.

The patient underwent cystoscopy deroofing of the ureterocele. The operating surgeon was the main author in a general hospital. The patient's recovery progressed well after doing the procedure. Three months later, she complained about an increasing dull right flank pain but had no incontinence nor sign of urinary tract infection. The laboratory investigations were within normal limits. CT urography with contrast was performed and showed a non-functional upper pole of the right kidney. Next, the patient underwent laparoscopic heminephrectomy for the non-functional upper moiety of the right kidney. The postoperative period remained uneventful. She followed up in outpatient surgery clinics. At follow-up, one month and six months after the surgery, the patient had recovered well and had no urological complaints.