Duplex renal collecting system with ectopic ureter insertion into vagina presenting with urinary incontinence in a teenage girl: A case report

Background Ectopic ureters, a rare congenital anomaly, occur when one of the ureters ends outside the bladder's trigone. This condition is more common in females and is frequently associated with duplex renal collecting systems. Although it is often diagnosed in childhood, cases may remain undetected until adulthood, especially when symptoms are mild. Case Presentation A 17-year-old female presented with urinary incontinence, a condition she had experienced since childhood. The incontinence was primarily daytime, characterized by intermittent small-volume dribbling without urgency or urinary tract infection symptoms. Ultrasound and CT imaging suggested a left duplex kidney with hydronephroureteric changes, raising suspicion of an ectopic ureter. Further investigations including cystoscopy, hysteroscopy, and vaginoscopy failed to identify the ectopic opening, prompting a pelvic exploration. During surgery, a double left ureter was found, with the upper moiety ureter inserted into the vagina. The stenosed portion of the upper moiety ureter was excised and re-implanted into the bladder. Discussion Ectopic ureters typically present with urinary incontinence, especially in females, due to their distal insertion near the urethral sphincter. In this case, mild symptoms and delayed presentation resulted in a later diagnosis. Imaging studies, such as CT IVU and ultrasonography, are critical for diagnosing duplex renal systems and ectopic ureters, though further surgical exploration may be required for definitive localization. Conclusion This case emphasizes the importance of considering duplex renal systems in young females presenting with urinary incontinence. Early diagnosis through comprehensive medical history, physical examination, and appropriate imaging is essential for effective management.