Congenital anomalies of the urinary tract, such as duplex collecting systems with ectopic ureteral insertion, are rare but significant causes of urinary symptoms and infections in infants. These anomalies, if not treated promptly, can lead to serious complications, including impaired renal function and chronic infections. This case highlights the importance of early diagnosis and surgical intervention in congenital urological anomalies, focusing on a 3-month-old baby girl who presented with concerning symptoms.
Case Presentation
A 3-month-old baby girl was referred to the Institute of Urology, Jaipur, with persistent symptoms of fever and on-and-off pyuria that had been occurring over the past two months. Her parents also reported continuous dribbling of urine from the urethra and possibly the vagina, raising concerns about an underlying urological abnormality.
Diagnostic Evaluation
Initial Imaging and Diagnosis
A detailed ultrasound (USG) examination was performed, revealing a duplex collecting system in the right kidney, with significant hydronephrosis of the upper moiety. The upper moiety ureter appeared grossly dilated, with ectopic insertion into the urethra, leading to the continuous dribbling of urine.
Further investigations, including CT urography, were conducted to confirm and expand upon the ultrasound findings. The CT urography results revealed:
- A duplex collecting system on the right side with hydronephrosis of the upper moiety.
- Gross dilation of the upper moiety ureter, with ectopic insertion into the urethra.
- Additional finding: Duplication of the left collecting system with double ureters in the proximal two-thirds, followed by fusion into a single ureter that drained normally via the ureterovesical junction (UVJ).
Surgical Planning and Intervention
Given the complexity of the case, a multidisciplinary approach was undertaken at the Institute of Urology, with senior urologists Dr. M. Roychowdhury and Dr. Rajan Bansal leading the surgical team. After detailed counseling with the baby’s parents and thorough discussions regarding potential risks and outcomes, the decision was made to proceed with a right upper moiety nephroureterectomy.
Surgical Procedure
The right upper moiety nephroureterectomy was performed successfully using state-of-the-art minimally invasive techniques. The ectopic ureter was meticulously dissected and removed, and the upper moiety of the duplex kidney was excised. The surgery was performed with precision, minimizing potential complications and ensuring optimal outcomes for the young patient.
Postoperative Care and Follow-Up
The baby recovered well postoperatively. A follow-up ultrasound conducted three days after the surgery demonstrated normal functioning of the remaining renal tissue, with no signs of hydronephrosis or obstruction. On subsequent follow-ups, the patient showed remarkable improvement. Her urinary symptoms had resolved, and she was thriving without any recurrent fevers or pyuria.
Discussion
Early Diagnosis and Management
This case underscores the critical role of early diagnosis and timely surgical intervention in congenital urological anomalies. The continuous dribbling of urine, coupled with recurrent infections, highlighted the severity of the ectopic ureter’s impact on the baby’s quality of life. The early use of imaging modalities such as ultrasound and CT urography facilitated accurate diagnosis and surgical planning, preventing further renal damage.
Significance of Expert Care and Advanced Techniques
At the Institute of Urology, Jaipur, we emphasize the importance of consulting specialists with extensive experience in pediatric urology. Our senior urologists, Dr. Roychowdhury and Dr. Bansal, bring years of expertise, ensuring that complex cases like this one are managed with the highest standards of care. Our team is committed to delivering excellent outcomes by adhering to continuously updated protocols based on international guidelines.
Technological Excellence and Modern Infrastructure
The Institute of Urology is equipped with the latest technology and surgical infrastructure, which is pivotal in managing intricate cases. Our advanced imaging tools and minimally invasive surgical techniques minimize risks and enhance recovery. We leverage internationally approved protocols to provide the most effective and safest treatments for our patients, ensuring they have the best chance at a symptom-free, normal life.
Conclusion
This case demonstrates the life-changing potential of early intervention in congenital urological anomalies. Timely surgical correction, performed by experienced specialists using cutting-edge technology, can prevent long-term complications and improve patient outcomes. The Institute of Urology, Jaipur, remains dedicated to offering unparalleled pediatric urological care, ensuring that each child receives the best possible treatment.
References:
- Peters, C. A., et al. (2016). “Duplex collecting systems and associated ureteral ectopy: a review of current management strategies.” Journal of Pediatric Urology.
- Smith, G. H., et al. (2014). “Outcomes of nephrectomy in infants with upper pole hydronephrosis and ectopic ureters.” Pediatric Surgery International.
- Decter, R. M., et al. (2018). “Long-term renal function after early intervention in congenital urinary tract abnormalities.” Pediatric Nephrology.
