Abstract
INTRODUCTION AND IMPORTANCE: Bilateral renal collecting system duplication is a rare condition in urology, and even rarer is the presence of an ectopic ureter. We described a case of bilateral renal collecting system duplication with an ectopic left-sided ureter opening into the urethra. The left side displayed complete renal collecting system duplication, while the right side showed incomplete duplication. CASE PRESENTATION: 55-year-old female was diagnosed with bilateral renal collecting system duplication and an ectopic left-sided ureter opening into the urethra. She underwent cystourethroscopy and ureteral-bladder anastomosis at our hospital. The patient was discharged after 5 days post-operation without significant discomfort. One month later, the double-J catheter was removed, and she reported no further incontinence during follow-up. CLINICAL DISCUSSION: Urinary incontinence is the most common complaint in females with ectopic ureters, as the ureteral opening bypasses the external urethral sphincter. Complete renal collecting system duplication is often associated with an ectopic ureter, resulting in persistent urinary incontinence. Notably, the patient did not experience incontinence during childhood, with intermittent incontinence only appearing over the past 3 years. For this patient, exploration surgery clarified the anatomical abnormality, and imaging showed that the upper pole of the left kidney had an acceptable cortical thickness, thus the decision was made to perform ectopic ureteral bladder reimplantation, which avoided excessive resection of the duplicated kidney and unnecessary anti-stress incontinence surgery. Therefore, for complicated cases, a staged treatment strategy is recommended, starting with exploratory surgery to clarify the patient's specific anatomy before determining the subsequent surgical approach. CONCLUSION: Bilateral renal collecting system duplication with an ectopic left-sided ureter opening into the urethra is extremely rare. Ureteral reimplantation can effectively reconstruct the urinary tract, and sometimes multiple surgeries are required, which should be chosen according to the patient's specific situation.