Images in Clinical Urology

Bilateral UretericQuadruplication With Renal CalculusVaibhav Saxena and Rajeev Kumar

Ureteric quadruplication is an extremely rare congenital anomaly. We present radiologic images of a young woman witha renal calculus with bilateral ureteric quadruplication. She presented with right flank pain, and the intravenousurogram revealed a calculus in the superior calyx that drained into the upper most moiety of a partially quadruplicated

ureter. UROLOGY 77: 592–593, 2011. © 2011 Elsevier Inc.

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A38-year-old nonpregnant woman presented withright flank pain of 6 months’ duration. She hadno additional symptoms or significant past his-

tory. There were no physical findings, and urine exami-nation and serum chemistry were normal. A radiopaqueshadow, suggestive of a renal calculus, was visible in the

From the Department of Urology, All India Institute of Medical Sciences, New Delhi,India

Reprint requests: Rajeev Kumar, M.Ch., Department of Urology, All India Institute

Figure 1. Plain X-Ray of the KUB region with a radio-opaqueshadow in the right renal region.

gof Medical Sciences, New Delhi 110029, India. E-mail: rajeev02@gmail.com

Submitted: March 8, 2010, accepted (with revisions): April 5, 2010

592 © 2011 Elsevier Inc.All Rights Reserved

right renal area on an X-ray of the kidney–ureter–blad-der region (Fig 1). An intravenous urogram was obtainedafter injecting 60 mL of a nonionic contrast medium.This revealed bilateral partial quadruplication of the ure-ters with malrotation of the left kidney (Figs 2 and 3).

he right renal calculus was located in the superioroiety. Both kidneys were functioning normally, with no

istal obstruction. All ureters on each side joined to formcommon ureter at the level of the L5 vertebra. The

atient has opted for shock wave lithotripsy for treat-ent.Ureteric quadruplication is an extremely rare con-

Figure 2. Ten-minute film after 60 mL intravenous contrastadministration, showing right partial ureter quadruplicationwith the stone in the superior calyx.

enital anomaly, with fewer than 10 reported cases.1 It

0090-4295/11/$36.00doi:10.1016/j.urology.2010.04.004

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administration, showing left partial ureter quadruplication.

UROLOGY 77 (3), 2011

has previously been reported unilaterally and bilater-ally, in association with ureteric cysts and inconti-nence.2-5 Triplication has been shown to predispose totasis, infection, and stone formation, and a similarathologic condition may have resulted in the stoneormation in our patient.6

References

1. Vicentini FC, Denes FT, Srougi M. Ureteral quadruplicationassociated with ureteral cyst and massive vesicoureteral refluxtreated by laparoscopic nephroureterectomy. J Endourol. 2007;21:769-771.

2. Klinge L, Kubiak R, Slongo T. Quadruplication of the ureter incombination with a large ureteral cyst. Pediatr Surg Int. 2001;17:566-568.

3. Lopes RI, Lopes RN, Barbosa Filho CM. Ureteral quadrupli-cation with contralateral triplicate ureter. J Urol. 2001;166:979-980.

4. Sourtzis S, Damry N, Janssen F, Perlmutter N. Ureteral quadru-plication: the fourth case report. Pediatr Radiol. 1994;24:604-605.

5. Soderdahl DW, Shiraki IW, Schamber DT. Bilateral ureteral qua-druplication. J Urol. 1976;116:255-256.

6. Hsu TH, Goldfarb DA. Blind-ending ureteral triplication. J Urol.

Figure 3. Fifteen-minute film after 60 mL intravenous contrast

1998;159:1295.

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