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Case Reports
. 2019 Dec 15;12(12):e229570.
doi: 10.1136/bcr-2019-229570.

Novel approach to locating a hypoplastic kidney in a unique variant of uterine didelphys syndrome presenting with continuous incontinence

Kathleen Rebecca Lockhart  1 , Megan Saul  2 , Allison Blatt  3
Affiliations
Case Reports

Novel approach to locating a hypoplastic kidney in a unique variant of uterine didelphys syndrome presenting with continuous incontinence

Kathleen Rebecca Lockhart et al. BMJ Case Rep. .

Abstract

Mullerian abnormalities such as uterine didelphys have an association with renal abnormalities. Ureteric ectopia must be considered as a differential diagnosis of incontinence. We describe the case of a 21-year-old woman who presented with low volume continuous incontinence with a history of right renal agenesis and uterus didelphys. A right kidney was not identified on CT intravenous pyelogram but excretory phase images suggested the presence of a right ureter. Diethylenetriaminepentaacetic acid renogram confirmed an area of perfusion consistent with a poorly functioning right kidney remnant. Cystoscopic investigation demonstrated an orthotopic left ureteric orifice, and an ectopic right ureteric orifice was identified in the posterior fornix of the right vagina. A laparoscopic right nephrectomy was performed, with a new application of indocyanine green aiding in identification of the right hypoplastic kidney with fluorescence imaging. The patient recovered well postoperatively and experienced complete resolution of incontinence, with preserved normal renal function.

Keywords: continence; renal intervention; surgical diagnostic tests; urinary and genital tract disorders; urological surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
MRI pelvis (coronal view) demonstrating uterine didelphys (arrows) and hemivaginas.
Figure 2
Figure 2
CT (coronal views): non-contrast (left) and delayed phase contrast (right) images.
Figure 3
Figure 3
Diethylenetriaminepentaacetic acid renogram demonstrating an area of perfusion at the right renal bed (diamond marker).
Figure 4
Figure 4
Examination under anaesthetic demonstrating midline vaginal septum.
Figure 5
Figure 5
Right ectopic ureter identified on vaginoscopy at the right vagina posterior fornix.
Figure 6
Figure 6
Intraoperative view following administration of indocyanine green; (A) and (C) normal view, (B) and (D) view under near-infrared fluorescence (NIRF) light.
Figure 7
Figure 7
Resected specimen, confirmed histologically to be right hypoplastic kidney and upper ureter (arrow), with adjacent soft tissue.
See this image and copyright information in PMC

References

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