BJU International 2001 87 (9), 903

C.L. Gupta, R.K. Chrungoo, S. Gupta and K.K. Gupta

Division of Urology, PG Department of Surgery, Medical College Jammu, J&K, India

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A 30-month-old ill-looking girl was admitted with a history of intermittent high-grade fever and pyuria present for the previous 20 months. On examination she had a soft cystic intra-abdominal swelling in the hypogastrium which persisted even after passing urine. Ultrasonography of the abdomen showed hydroureteronephrosis on the left side. There were no other congenital abnormalities detected. A micturating cystogram showed VUR on both sides with two filling defects at the base of the bladder. IVU showed no excretion of contrast medium on the left side, while it was normal on the right. The tentative diagnosis was VUR with a non-functioning left kidney. At surgery, two separate kidney-ureter-bladder systems with a separate blood supply were found on the left side; both of these kidneys were atrophic and attached to each other by loose connective tissue. One ureter drained into the main urinary bladder and the other into the sac on its left side (Fig. 1). The main left urinary system (nephroureterectomy), the supernumerary kidney and the para-vesical sac were all excised and removed. Histopathology of the specimens showed two atrophic kidneys and two ureters; the para-vesical sac had a similar structure to the urinary bladder.

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Duplication of organs may be genetically determined by an autosomal dominant trait with incomplete penetrance. Reports also suggest a positive role for environmental factors [1,2]. In supernumerary kidneys with bifid ureters, one bud bifurcates and each branch independently penetrates a metanephric mass which develops into a separate reniform kidney [3]. Complete duplication involves two bladder halves each with a full thickness of muscular wall and each with its ipsilateral ureter and urethra. Incomplete bladder duplication, where there is no urethral duplication, has been reported. This anomaly involves two full-thickness bladders each drained by its ureter; these communicate and drain into a common urethra. The association of a supernumerary kidney with complete duplication of the urinary tract but with no urethra has not been reported previously. The absence of other congenital anomalies makes the present case particularly rare.

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C.L. Gupta, MS, MCh, Professor.

R.K. Chrungoo, MS, FICS, Assistant Professor.

S. Gupta, MS, MCh, Lecturer in Surgery.

K.K. Gupta, MS, Senior Resident in Surgery.