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  • The Internet Journal of Urology
  • Volume 7
  • Number 1

Original Article

Primary obstructive mega ureter- lower moiety

P Kumar, K Natarajan, K Sasidharan

Keywords

moiety disease, primary obstructive megaureter

Citation

P Kumar, K Natarajan, K Sasidharan. Primary obstructive mega ureter- lower moiety. The Internet Journal of Urology. 2009 Volume 7 Number 1.

Abstract

Primary obstructive megaureter (POM) in a single system is a common entity. Lower moiety of a duplex system is usually associated with reflux. Here in we present a case of primary obstructive megaureter (POM) in a lower moiety of a duplex system.

 

Case Report

A 12 year old male presented with history of dull aching pain in right loin of 4 year duration. General examination was unremarkable. Blood and urine examination were normal. Sonography revealed right kidney showing gross hydroureteronephrosis. IVU showed bilateral duplicated system, right upper moiety was normal and draining well, right lower moiety showed delayed excretion with hydroureteronephrosis (Fig 1). Contrast CT revealed thinned out right lower moiety parenchyma with gross hydroureteronephrosis extending up to bladder (Fig 2).DTPA revealed poor radiotracer uptake by lower moiety. Micturating cystoureterogram did not reveal any reflux. Cystoscopy showed normal looking upper moiety orifice and hypoplastic lower moiety orifice. Exploration through 12th rib bed done showed thinned out lower moiety parenchyma with gross hydroureteronephrosis distal 3 cm of ureter was narrow, suggestive of primary obstructive megaureter (Fig 3). Child underwent excision of the lower moiety with the ureter.

Figure 1
IVU showing bilateral duplex system with right lower moiety hydroureteronephrosis

Figure 2
Reconstructed CT shows right hydroureteronephrosis up to the bladder

Figure 3
: Intra Op Photo Shows Dilated Lower Moiety Ureter with Narrowed Distal 3 Cm Of Ureter

Discussion

Ureteric duplication is not uncommon; occurs in 0.8% of patients 1,4. Bilateral duplicated system is relatively rare entity. Hydronephrosis of the lower moiety is not infrequent and generally associated with reflux. Obstruction occurs commonly in upper moiety. Obstruction in lower moiety is not very uncommon, usually due to PUJ obstruction 2,4, 5 calculi, epithelial tumour, and ectopic upper pole ureterocele compressing the lower moiety orifice. Lower moiety obstruction due to primary obstructive megaureter is an uncommon entity3

References

1. Nation EF : Duplication of kidney and ureter: A statistical study of 280 new cases. J .urol 1944; 51: 456
2. Dahl DS : Bilateral complete renal duplication with total obstruction of both lower pole collecting system. Urology 1975 Dec;6(6):727-9
3. Lee PH ,Diamond DA : Rare variant of isolated lower pole hydronephrosis; Primary obstructive megaureter. Urology: 1991 April; 37(4); 344-6
4. Fernbach SK, Zawin JK : Complete duplication of the ureter with ureteropelvic junction obstruction of the lower pole of the kidney. AJR Am J Roentgenol 1995Mar;164(3):701-4
5. Amis ES Jr, Cronan JJ, Pfister RC :Lower moiety hydronephrosis in duplicated kidneys.Urology 1985 Jul ; 26(1) :82-8.

Author Information

P.B Barani Kumar, MS, MCh
Division Of Urology, Kasturba Medical College

K. Natarajan, MS, FRCS (EDIN), FRCS (IRE), DNB, MCh
Division Of Urology, Kasturba Medical College

K. Sasidharan, MS, MCh
Division Of Urology, Kasturba Medical College

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