陳浩瑋1、陳妤甄1、阮雍順2、吳文正1、李香瑩1,2

高雄醫學大學附設醫院 泌尿科1

高雄大同醫院 泌尿科2

Hao-Wei Chen¹, Yu-Chen Chen¹, Yung-Shun Juan², Wen-Jeng Wu¹, Hsiang-Ying Lee^1,2

¹Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

²Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

 

A 72-year-old woman was referred to our hospital due to recurrent urinary tract infection (UTI) for several months. She denied other underlying disease. Her physical examination was normal. Right hydronephrosis was identified by ultrasound (Figure provided). Urine analysis showed pyuria with bacteriuria. Lab data revealed normal renal function. Intravenous pyelogram (IVP) revealed no obvious obstruction of contrast in patient's kidneys, ureters and bladder, but a 2.5-cm abdominal calcification instead of urolithiasis (Figure provided). However, refractory UTI was noted after antibiotic treatment and right hydronephrosis was still 2 weeks later. This fact led us to re-evaluate the urinary system. Further computed tomography scan revealed duplication of right renal collecting system with one of the bifid ureter obstructed by the ureter stone (Figure provided). After the percutaneous nephrolithotomy, the patient’s health improved.

Duplex kidney with obstructive urolithiasis can mimic other abdominal calcification instead of urolithiasis when there’s no contrast passed though and no obstruction of contrast shown in IVP. A bifid ureter, incomplete duplication of a duplex collecting system, with the total occlusion by a large stone in one ureter can present normal IVP finding. This finding may lead to a misdiagnosis by first-line physicians. This can be avoided by being aware of a refractory UTI combined with persistent hydronephrosis, indicating that the urinary system is in fact abnormal; and further survey is necessary. This difference allows us to differentiate between these two hard to distinguish entities. In this case, refractory UTI could be treated by surgery.