Ureteral Ectopia, a Rare Cause of Uretero-Urethral Fistula in a Patient with Bilateral Duplex Kidneys: A Case Report and Review of the Literature

Abstract

Introduction: Ureteral ectopia (UE), a congenital malformation characterized by the presence of a ureter opening outside the bladder trigone, manifests as a ureterourethral fistula (URF). The presence of bilateral duplication of the kidneys and ureters is a rarer condition in urology. Methodology: This is a descriptive study of a 17-year-old female patient treated at the HGR SENDWE in December 2024 for UE with UUF on a bilateral duplex kidney. Case Presentation : This is a 17-year-old patient who came for consultation for urinary incontinence since birth, characterized by constant involuntary loss of urine through the vagina associated with a feeling of needing to urinate at times, since the age of 3. She had consulted traditional practitioners and other doctors without success. On physical examination, her vulva was soiled with urine, we did not observe any vulvar fistula, and the methylene blue test was negative. After imaging tests, a diagnosis of complete bilateral duplex kidney with right ureteral ectopia was made. During surgery, we identified a bifid double collecting system. Using a methylene blue test via the ureters, we identified the ectopic ureter. After performing cystotomy and ureteral reimplantation, we left a JJ ureteral stent and a Foley urinary catheter in place. The postoperative period was marked by dry bedding the day after the procedure. Conclusion: Ureteral ectopia remains one of the rare causes of uretero-urethral fistulas, and its detection in cases of bilateral duplex kidneys is still very rare. The diagnosis is based on medical history, clinical findings, and imaging. Treatment remains surgical, with generally favorable postoperative outcomes allowing for successful social reintegration.