Challenges of Management of Duplex System Ureterocele in an 18-Year-Old Woman: A Case Report

Background: Ureterocele is a cystic dilatation of the intravesical part of the ureter. Duplex system ureterocele is rare and occur more in females. Patients usually present with recurrent abdominal pain and urinary tract infection. The diagnosis and the treatment of duplex system ureterocele in women may pose diagnostic and therapeutic dilemma. We report a case of duplex system ureterocele in a woman highlighting diagnostic and therapeutic challenges. Case report: This is 18-year-old woman who presented with recurrent right flank pain, intermittent fever of 7months duration and lower urinary tract symptoms. There was right renal angle tenderness on abdominal examination. Abdominopelvic ultrasound and computerized tomographic scan urogram (CTU) revealed right hydronephrosis and a ureterocele. Accurate diagnosis was missed by all the imaging studies done. She had excision of the ureterocele and common sheath reimplantation of the two ureters on account of duplex system ureterocele. She had uneventful recovery. The urethral catheter, stents, drain and the stitches were remove 15 and 16 days postoperatively. She was discharged 20 days post operatively. Conclusion: Duplex system ureterocele may present with recurrent pyelonephritis. Computerized tomographic scan urogram is necessary for accurate diagnosis. There may be diagnostic and or therapeutic challenges. Common sheath ureteral reimplantation is associated with good outcome.