Sagittal septum duplication of bladder and duplication of posterior urethra combined with congenital megacolon: a case report and literature review

Abstract

Background: Duplication of the bladder with duplication of the posterior urethra is a relatively rare congenital malformation. Cases of sagittal septum duplication of the bladder with duplication of the posterior urethra have rarely been reported. Furthermore, the combination thereof with congenital megacolon is rare.

Case presentation: A 21-year-old male was admitted to our hospital because of frequent urination for two months. He presented to another hospital first with frequent urination and underwent computed tomography (CT) and testicular biopsy. Anti-inflammatory therapy was administered by the doctor to the patient. For further diagnosis and treatment, the patient went to the outpatient department in our hospital on June 6, 2022. After admission, the patient underwent ultrasound, CT, MRI, cystoscopy, and other related examinations and tests. The examination results suggested that the patient had duplication of the bladder with duplication of the posterior urethra. In addition, the patient's mother reported that he had suffered from long-term constipation with abdominal distension before the age of 5 years. At the time, he was admitted to the local hospital and was diagnosed with congenital megacolon based on the relevant examinations. After the patient was diagnosed with duplication of bladder and urethra, the doctor recommended surgical treatment to the patient. However, he considered that he only had frequent urination symptoms, and chose conservative treatment rather than to undergo surgical treatment. Thus, the doctor prescribed anti-inflammatory treatment. Four months later, the patient reported that frequent urination symptoms persisted, and was also considering fertility-related problems. The outpatient follow-up will be continued.

Conclusions: In this article, we summarize the imaging findings of duplication of the bladder with duplication of the posterior urethra and propose the advantages and disadvantages of each type of imaging examination. We also review the relevant literature on cases of bladders with duplication of the posterior urethra. The related differential diagnosis is summarized, and the significance of guiding clinical treatment and diagnosis is discussed.

Keywords: Case report; Computed tomography; Duplication of the bladder; Magnetic resonance imaging.

Fig. 1

Urinary ultrasound: the left and right bladders (BL) were not connected, which were separated by a septum (white arrow)

Fig. 2

Urinary CT: cross-sectional images: a separation of seven millimeters (white and black arrow) in the bladder (A-B), there are two contrasts filled chambers in the pelvic cavity. MIP coronal view: the left and right kidneys were connected to each side of an independent ureter, and the two bladder cavities were side by side (C-E). VR: the entire urinary system can be seen. The left and right kidneys and a single ureter connect the left and right bladders (F)

Fig. 3

MRI: T1WI, T2WI cross-section and coronal plane: two chambers in the pelvic arranged left and right, the two chambers were separated by a sagittal septum, and septum shape and signal were similar to the bladder wall (A-C). MRU: two bladders were connected to the bilateral posterior urethra respectively (D-E). 3D: two half-bladders and two posterior urethras (F)

Fig. 4

Cystoscopy: the left and right urethras were seen in the membranes part of the urethra (A), the left posterior urethra was irregular in shape, the mucosa was not smooth, and there was no verumontanum structure (B), the right posterior urethra’s verumontanum structure was visible (C)

Fig. 5

The flow chart of the literature screening process for sagittal bladder duplications and duplication of posterior urethra