Type I Ureteral Triplication in an Adult Associated With an Obstructed Extravesicular Megaureter Surgically Managed With Partial Nephrectomy

Abstract

A complete ureteral triplication is a rare congenital urinary tract anomaly that typically presents in childhood. This is an exceedingly rare case of an adult male presenting with right pyelonephritis and flank pain who was subsequently diagnosed with a right type I ureteral triplication associated with an obstructed megaureter inserted into the prostatic urethra. This patient underwent a right partial nephrectomy to remove the dilated and non-functional upper renal segment leaving behind a blind ending ureteral remnant. Following partial nephrectomy, the patient's flank pain and recurrent urinary tract infections resolved despite persistent dilation of the ureteral remnant. While a standard method of surgical management for a triplicated ureter has not been well established in the adult population, in this case, partial nephrectomy has demonstrated efficacy while avoiding more invasive procedures.

Keywords: adult; extravesicular ureter; partial nephrectomy; prostatic ureter; type i triplicated ureter; weigert-meyer law.

Figure 1. CT abdomen and pelvis without contrast prior to surgery

(A) Coronal view of the right kidney revealing severe hydronephrosis of the right kidney with cystic changes. Notice the dilation of the ureter from the upper pole indicated by the black arrow. (B) Sagittal view of severely hydronephrotic right ureter inserting into the posterior prostatic urethra (black arrow).

Figure 2. CT abdomen and pelvis with contrast three years post-operatively

(A) Coronal view of the right kidney with resolution of hydronephrosis. Notice the dilated ureteral remnant adjacent to the kidney, marked by the black arrow. (B) Sagittal view of right ureter inserting into the posterior prostatic urethra demonstrating worsened hydronephrosis (black arrow).