Calculus Induced Hydroureteronephrosis Obstructive Syndrome in a Patient with Two Separate Pelvicalcyeal System in Right Side with Bifid Ureter: A Rare Clinical Entity.

Abstract

Hydroureteronephrosis is a clinical condition where the dilatation of renal calyces and ureter occur jointly due to obstruction. When two ureters arise from single kidney the situation is known as bifid ureter which may be complete or
incomplete. The present study examines a congenital anomaly of bifid ureter and rare clinical presentation of calculus
induced obstructive hydroureternephrosis in a adult male aged 38 by past 48 hours. The common symptoms of this
condition were extreme intolerable pain in the abdomen, flank pain moderate to severe radiate to loin to groin,
vomiting/nausea and haematuria. Diagnosis was done by injection of intravenous dye and computed tomography
intravenous pyleogram was performed along with lab findings. In this case we found two incomplete ureters i.e. bifid
nature arising from right kidney that unite as a single ureter before emptying into the urinary bladder. There was presence of single large calculus measuring approximately 8.6*8mm right at the junction of bifid ureter at the level of L3 vertebra inducing hydroureteronephrosis. Similarly marked upstream dilation of upper right ureter was found. The anomaly of bifid ureter occurs due to the untimely division of ureteric diverticulum. Unless some complication of ureter occurs, the duplication does not expose itself. Acute obstruction of ureter does not cause any significant alternation in renal function. Though the whole clinical presentation is rare itself, it further needs follow ups to avoid re-occurrence.