Urology Annals
About UA | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionLogin 
Urology Annals
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 384   Home Print this page  Email this page Small font size Default font size Increase font size


 
Table of Contents
CASE REPORT
Year : 2015  |  Volume : 7  |  Issue : 1  |  Page : 88-90  

Incomplete bladder duplication with multiple congenital anomalies: A rare presentation


Department of Urology, I. P. G. M. E. & R., Kolkata, West Bengal, India

Date of Submission02-Apr-2013
Date of Acceptance31-Jul-2013
Date of Web Publication6-Jan-2015

Correspondence Address:
Nipun Kumar Awasthi
242, A. J. C. Bose Road, S. S. K. M. Hospital, Kolkata - 700 020, West Bengal
India
Login to access the Email id


DOI: 10.4103/0974-7796.148628

PMID: 25657553

Rights and Permissions
   Abstract 

We report a rare case of incomplete bladder duplication associated with multiple congenital malformation. The patient presented with a symptomatic left pelvi-ureteric junction obstruction which was surgically managed. To the best of our knowledge, this type of bladder duplication with such syndromic association is not yet reported in literature.

Keywords: Bladder duplication, scoliosis, septate uterus


How to cite this article:
Awasthi NK, Goel H, Mahapatra R, Pal D. Incomplete bladder duplication with multiple congenital anomalies: A rare presentation. Urol Ann 2015;7:88-90

How to cite this URL:
Awasthi NK, Goel H, Mahapatra R, Pal D. Incomplete bladder duplication with multiple congenital anomalies: A rare presentation. Urol Ann [serial online] 2015 [cited 2020 Jul 12];7:88-90. Available from: http://www.urologyannals.com/text.asp?2015/7/1/88/148628


   Introduction Top


Bladder duplication is an extremely rare condition. Incomplete duplication of the bladder is an unusual congenital anomaly and is usually associated with other congenital anomalies. [1] It is found more commonly in males than in females. [2] We present a case of incomplete bladder duplication in a female with associated septate uterus, uterine fibroid, anorectal malformation, with unilateral (left) pelvi-ureteric junction obstruction, and poorly functioning kidney. To the best of our knowledge, this type of bladder duplication with such syndromic association is not yet reported in literature.


   Case Report Top


A 20-year-old female presented with the complaint of left-sided flank pain for last 6 months with occasional stress urinary incontinence and primary infertility. On physical examination, a patulous urethral opening was seen and anal opening was separated from the vagina by a thin septum. A single urethral meatus was observed. Ultrasound showed grossly hydronephrotic left kidney [Figure 1] with uterine fibroid [Figure 2]. Intravenous urography suggested septate bladder with scoliosis [Figure 3]. Magnetic resonance imaging showed septate bladder [Figure 4] and uterine septation [Figure 5]. Diehylene Triamine Penta Acetic acid (DTPA)renogram showed poorly functioning left kidney with type 2 curve. Left transperitoneal laparoscopic pyeloplasty was done with double-J stenting. Postoperative recovery was uneventful and the stent was removed after 4 weeks. At 6 months follow-up, patient is doing well without any flank pain and with improved left renal function on follow-up DTPA diuretic renogram. Patient was advised for treatment of septate bladder and septate uterus, but she was unwilling to undergo any further investigations or interventions.
Figure 1: Ultrasound Kidney Ureter Bladderl (KUB) showing left hydronephrosis

Click here to view
Figure 2: Ultrasound showing fibroid uterus

Click here to view
Figure 3: IVU showing incomplete bladder duplication with scoliosis

Click here to view
Figure 4: MRI showing incomplete bladder duplication

Click here to view
Figure 5: MRI showing septate uterus

Click here to view



   Discussion Top


Bladder duplication may be complete or incomplete. Depending on the axis of the septum, it can occur at the sagittal or coronal plane .[3] Abrahamson classified the various bladder duplication anomalies and found complete duplication in the sagittal plane to be more common [3] compared to the coronal one, in a ratio of 2.5:1. [4] Females are more likely to present the sagittal type of duplication. [3] In incomplete bladder duplication, two bladders communicate with each other and drain into a common urethra. To determine the anatomic situation, a complete preoperative diagnostic evaluation with karyotype, ultrasound, Intra Venous Urography (IVU), video-urodynamic studies, genitogram, and gastrointestinal tract imaging is helpful. [3]

Kossow and Morales reviewed 40 cases of complete bladder duplication and 90% of cases showed associated duplication anomalies of the external genitalia. Associated duplication anomalies of the lower gastrointestinal tract have been reported in up to 42% of cases and spina bifida, meningocele, or myelomengocele has been reported in 15% of cases. [5] Berrocal et al. also showed associated duplication anomalies of the external genitalia, gastrointestinal malformations, duplications of the spine, spina bifida conditions, and various fistula formations between the urogenital and gastrointestinal tract. [6]

Due to the variety of presentations with other associated anomalies and rarity of the disease, the treatment cannot be standardized and should be individualized. Renal preservation and prevention of infections by relieving obstructed genitourinary tracts should be the aim of initial treatment. Further treatment should be reconstruction of the internal and external genitalia with an aim to achieve continence. Incomplete duplications may not require surgical procedures if both bladder halves are sufficiently drained by a common urethra. [3]

 
   References Top

1.
Varga G, Pacík D. Complete duplication of the urinary bladder and the urethra in a woman - a case report with a review of articles. Scr Med 2009;82:115-22.  Back to cited text no. 1
    
2.
Santiago FG, Zael SR, Rodrigo PB, Alejandro UO, Jose M, Gerardo FN, et al. Surgical management of complicated bladder exstrophy with genital and bladder duplication. Rev Mex Urol 2012;72:17-21.  Back to cited text no. 2
    
3.
Wein JA Kavoussi RL, Novick CA, Partin WA, Peters AC, Editors. Campbell-Walsh Urology. 10 th ed. Philedelphia, U.S.A: Elsevier Saunders; 2011. p. 3385-8.  Back to cited text no. 3
    
4.
Metzge R, Schuster T, Stehr M, Pfluger T, Dietz HG. Incomplete duplication of the bladder - A case report. Eur J Pediatr Surg 2004;14:203-5.  Back to cited text no. 4
    
5.
Voigt HR, Wentzel SW. Complete duplication of the bladder, urethra and external genitalia in a male neonate with an imperforate anus. Int J Urol 2005;12:702-4.  Back to cited text no. 5
    
6.
Berrocal T, Novak S, Arjonilla A, Gutiérrez J, Prieto C, Urrutia MJ. Complete duplication of bladder and urethra in the coronal plane in a girl. Pediatr Radiol 1999;29:171-3.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed2813    
    Printed37    
    Emailed0    
    PDF Downloaded220    
    Comments [Add]    

Recommend this journal