Ectopic ureter opening into the vagina in an adult with duplex kidney: a case report and literature review

Introduction: Duplex kidney with an ectopic ureter typically presents with continuous urinary incontinence in childhood. Adult females presenting with renal colic and intermittent vaginal discharge are rare, especially when initial ureteroscopy is normal. Methods: We report a 26-year-old woman with a one-week history of severe right flank pain, each episode accompanied by a small amount of clear, odourless vaginal discharge. She had undergone caesarean section four months earlier. Non-contrast computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance urography (MRU) were performed, followed by ureteroscopy and laparoscopic exploration. Results: Non-contrast CT suggested a right duplex kidney with dilatation of the upper-pole ureter but could not identify the distal termination. MRU clearly demonstrated a complete right duplex system with a markedly dilated and tortuous upper-pole ureter that did not connect to the bladder; T2-weighted fat-saturated images showed the terminal ureter entering the vaginal region. Ureteroscopy revealed a normal-appearing ipsilateral ureteric orifice. Laparoscopy identified a 2-cm diameter ectopic ureter behind the broad ligament, with its distal opening into the vagina. Laparoscopic ligation of the ectopic ureter followed by ureteroneocystostomy resulted in complete resolution of symptoms. Discussion: In adult women presenting with renal colic and intermittent vaginal discharge, a duplex kidney with an ectopic ureter should be suspected even when ureteroscopy is normal. Non-contrast MRI combined with MRU is the best non-invasive imaging method for diagnosis.