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    Go to the top of the page   ID: 20040123095758 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Bladder Diverticulum with Double Kidneys and Duplicated Ureter
    Dirk Schaper, P Göbel. Bladder Diverticulum with Double Kidneys and Duplicated Ureter. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040123095758


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are Ultrasound-images available for this case. [ Ultrasound ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Dirk Schaper, P. Göbel (Kinderchirurgie St. Barbara-Krankenhaus Halle/S.)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    5 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    Pelvis-Urinary bladder  

     
     Pediatric Radiology CasesMost likely etiology:

    congenital  

     
     Pediatric Radiology CasesHistory:

    5 year-old boy without clinical complaints. Incidental findings on sonogram (Ultrasound 1) in the course of treatment for balanitis. Right-sided duplicated urinary tract system without urinary obstruction. Left: unremarkable kidney.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    N/A  

     
     Pediatric Radiology CasesRadiological findings:


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Abdomen axial, bladder with an unclear, echogenic structure to the left in the trigonal region.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Voiding cystourethrogram (VCUG) ap, left-sided vesico-ureteral-reflux (VUR) III°







    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Voiding cystourethrogram (VCUG) oblique view, during urination. Bulging of the bladder dorsolaterally with oblique VUR III° on the left side, The left pelvicocaliceal system resembles a wilting flower .






    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Voiding cystourethrogram (VCUG): further enlargening of the structure during micturition.






    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Abdomen axial, anechoic structure on the left side, changing in size during the exam, no depiction of the ureter.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Lower abdomen axial: Again demonstrated is the anechoic strcuture on the left, which is changing in size during the continuous examination. When the bladder contracts, enlargening.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Sonogram during urination, an obvious enlargening of the pathology




    Ultrasound 5 <- view Ultrasound 5

    Ultrasound 5: Bladder continues emptying, pathology becomes larger.




    Ultrasound 6 <- view Ultrasound 6

    Ultrasound 6: Bladder is empty, pathology further enlarged.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Intraoperative findings



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Surgery / Histo  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Ureterocele, parostial diverticlum, megaureter  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Since the sonographic image was initally unclear, a cystoscopy was performed. This showed a widened ostium in a prominent mucous membrane without signs of the diverticulum's entry side and without proof of a second ostium. In the VCUG, reflux to the lower pole moiety was demonstrated. The left pelvicocaliceal system resembled a wilting flower which allows the suspicion of a duplicated renal system.


    In the MAG3 scintigraphy, the functioning part of the left kidney was measured as 25.5%. No proof of an upper moiety.

    This resulted in an operation to resect the diverticulum and to replant the ureter. Intraoperatively, a second, hypoplastic ureter is seen, which does not show urine flow and is not able to be probed. The diverticulum is large, the ureter of the lower moiety connects inserts into the central portion of the diverticulum. The connection with the second ureter could not be seen. A resection of the diverticulum and the neoimplantation of the ureter into the lower moiety was performed. The hypoplastic ureter has been resected.  

     
     Pediatric Radiology CasesComments of the author about the case:

    The overall pathology is difficult to interpret. Is this a bladder diverticulum, in which both ureters join, or is this a protruded ureterocele? Because of the intraoperative situation and the obvious hypoplasia of the upper pole moiety uereter, it seems rather unlikely that this is a protruded ureterocele. Furthermore, a histological examination does not describe a ureterocele.

    In the follow-up examination and after the ureter was re-implanted, the left kidney is not dilated. An upper pole moiety is still not able to be demonstrated.
     

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Minevich E, Moayed A, Wacksman J, Lewis AG, Sheldon CA.
    Unusual anatomic presentation of ectopic ureteroceles
    J Pediatr Surg. 1999 Mar; 34(3): 474-6

    2. Medline: Medline
    Bellah RD, Long FR, Canning DA
    Ureterocele eversion with vesicoureteral reflux in duplex kidneys: findings at voiding cystourethrography
    AJR Am J Roentgenol. 1995 Aug; 165(2): 409-13

    3. Medline: Medline
    Beasley SW, Kelly JH
    Inverted Y duplication of the ureter in association with ureterocele and bladder diverticulum
    J Urol. 1986 Oct; 136(4): 899-900  

     
     Pediatric Radiology CasesKeywords:

    duplicated kidney, duplicated collecting system, double kidney, bladder diverticulum, double, kidney, bladder, diverticulum, duplication, duplication of renal collecting system, renal duplication, ureteral duplication, ureter duplication, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Dirk Schaper, P Göbel. Bladder Diverticulum with Double Kidneys and Duplicated Ureter. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040123095758  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Pelvis-Urinary bladder
    or in the region: Pelvis
    or in the tissue/organ: Urinary bladder
    or with the etiology: congenital
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are Ultrasound-images available for this case. [ Ultrasound ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     
    Bladder Diverticulum with Double Kidneys and Duplicated Ureter
    Dirk Schaper, P Göbel. Bladder Diverticulum with Double Kidneys and Duplicated Ureter. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040123095758


     

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    Bladder Diverticulum with Double Kidneys and Duplicated Ureter
    Other cases by these authors:

    Search Dirk Schaper in Medline Dirk Schaper (43)   
    Search P. Göbel in Medline P. Göbel (6)   

    Bladder Diverticulum with Double Kidneys and Duplicated Ureter  
     
    Bladder Diverticulum with Double Kidneys and Duplicated Ureter
    Dirk Schaper, P Göbel. Bladder Diverticulum with Double Kidneys and Duplicated Ureter. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040123095758


     

    Which diagnosis have other collegues guessed?


    • Ureterocele
      Votes: 2 (10 %)


    • Parostial diverticlum
      Votes: 10 (50 %)


    • Megaureter
      Votes: 1 (5 %)


    • Bladder diverticulum in double kidney and duplicated ureter
      Votes: 7 (35 %)



        Total answers: 20

     
    Bladder Diverticulum with Double Kidneys and Duplicated Ureter
    Dirk Schaper, P Göbel. Bladder Diverticulum with Double Kidneys and Duplicated Ureter. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040123095758


     

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    Bladder Diverticulum with Double Kidneys and Duplicated Ureter
    Dirk Schaper, P Göbel. Bladder Diverticulum with Double Kidneys and Duplicated Ureter. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040123095758


     




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