Segmental dilatation of ureter: Report of two cases
A 14-month-old male child presented with abdominal distension and pain of 2 months duration. USG revealed moderate hydronephrosis on right side; ureters were not seen. A thick-walled cystic structure with thick fluid inside (4 cm × 3 cm) was noted on right side just above the bladder. IVP showed right-sided hydronephrosis, as the radiologist missed the non-functioning lower moiety. Left kidney was normal. MCUG showed normal urinary bladder and no reflux. Renal biochemical parameters were within normal limits. At operation, right-sided duplex kidney was noted. Normal size upper moiety ureter (8 cm long) drains into the dilated segment (3 cm × 2 cm). The small lower moiety and dilated upper ureter (4 cm long) drains into a markedly dilated, thickened ureteral segment (6 cm × 4 cm). The dilated segments were densely adherent to the bladder wall and extended up to the recto-vesical pouch. Normal size lower ureters of both moieties opened into the bladder separately. Partial nephroureterectomy (lower moiety) was done with excision of the dilated segment of both upper and lower moiety ureters. Normal upper moiety ureter was re-implanted into the bladder by Leadbetter-Politano technique. Histology of the lower moiety showed features of XGP []. The patient had uneventful recovery and was doing well till last follow up at 18 months.