Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

24 Year-old Woman with UTI and History of Duplex Kidney and Ureterocele as a Child

This 24 year-old woman had a urinary infection at age 2 years which led to a VCUG that showed a large ureterocele in the bladder. An IVP (Figure 1) showed a left mid-bifid ureter. The left kidney was otherwise normal. On the right, there was a normal lower pole and a nonfunctioning, dilated upper pole. Approximately 21 years ago, she underwent upper pole nephrectomy and partial ureterectomy with decompression of the ureterocele from above. She recently began to experience some occasional difficulty voiding and began to have urinary tract infections. IVP (Figure 2) showed a normal left duplex kidney and a normal right lower pole. VCUG was normal. A ureterocele was not seen and there was no reflux.

At cystoscopy, the collapsed ureterocele was identified and injected (Figure 3). Contrast material filled the ureterocele at the bladder neck and the blind-ending stump of the upper pole ureter. The bladder was mildly trabeculated. She underwent excision of the ureterocele and the remainder of the upper pole ureter.

Intravenous Pyelogram

Figure 1 Left Mid-Bifid Ureter

Figure 2 Left Duplex Kidney

Figure 3 Collapsed Ureterocele