Ectopic ureter insertion into vagina

Case contributed by Dr Mostafa El-Feky

Presentation

Urinary incontinence

Patient Data

Age: 30 years
Gender: Female

MR urography (MRU)

MRI

Complete duplication of the right collecting system. 

The upper moiety shows no remaining visible parenchyma, dilated pelvicalyces and dilated tortuous ureter (18 mm) inserting in the vaginal fornix, best demonstrated at T2 axial images. 

The lower moiety measures 11 x 6.5 x 5 cm, showing normal shape, parenchymal thickness (19 mm), signal pattern and position. Preserved corticomedullary differentiation.  

Normal configuration of the right lower moiety pelvicalyceal system, its ureter, as well as the left ureter, with no signal defects or back pressure changes identified.

Normal site, size, and shape of the left kidney, showing normal parenchymal thickness (21 mm), signal pattern and preserved corticomedullary differentiation.  Mild (grade I) left calyceal dilatation.

No renal solid or cystic lesions identified. No collections identified.

Normal configuration of the urinary bladder, with no signal defects or mural lesions. No visible ureterocele.

Case Discussion

Radiological features represents complete duplex configuration of the right collecting system, with total upper moiety atrophy and calyceal dilatation. Ectopic right upper moiety ureter insertion into vaginal fornix.

Duplex renal collecting system is a common renal anatomical variant. In a case of complete duplication, the moieties (portions) obeys the Weigert-Meyer rule, the upper moiety ureter inserts more medial and more inferior to the lower moiety ureter and liable for obstruction. 

Ectopic insertion of the ureter is rare urinary tract anomaly, with the ureter inserting into nearby pelvic organs other than the urinary bladder such as the vagina, seminal vesicle, or urethra. MR urography is an excellent imaging modality in detection of ectopic ureter in children 1. In females, the vagina represents about 25% of sites of ectopic insertion of the ureter after upper urethra insertion (33%) and the vestibule (33%) 2.

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