A case of right hypodysplastic kidney and ectopic ureter associated with bicornuate uterus in a prepubertal girl

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This case report details a prepubertal girl diagnosed with a hypodysplastic right kidney and ectopic ureter, concurrently found to have a bicornuate uterus.

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This paper reports a premenarchal girl initially diagnosed with right multicystic dysplastic kidney who later developed continuous urinary incontinence; subsequent workup using contrast-enhanced CT, cystoscopy, colposcopy, ureterography, and hysterosalpingography led to a final diagnosis of right hypodysplastic kidney and ectopic ureter associated with a bicornuate uterus. The authors note that a strong family history of uterine malformations prompted further uterine evaluation, and although genetic testing was suggested, the family declined. A key caveat is that the authors could not pursue genetic confirmation, limiting interpretation of underlying etiology. The paper relates to endometriosis and/or adenomyosis because it discusses the risk of later gynecological complications such as endometriosis associated with delayed recognition of Mullerian anomalies in girls with CAKUT. This paper does not explicitly discuss adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Congenital anomalies of the kidney and urinary tract (CAKUT) are frequently associated with Mullerian anomalies. This can be explained by the fact that Mullerian duct elongation depends on the preformed Wolffian duct during embryogenesis. While CAKUT such as unilateral renal agenesis and multicystic dysplastic kidney are commonly identified prenatally by routine ultrasound, the diagnosis of Mullerian anomalies is often delayed, increasing the risk of complications such as endometriosis or pelvic inflammatory disease. Herein, we report a case of a premenarchal girl who had initially been diagnosed with right multicystic dysplastic kidney. She presented with continuous urinary incontinence at 4 years old and further evaluation by contrast-enhanced computed tomography, cystoscopy, colposcopy, ureterography, and hysterosalpingography led to the final diagnosis of right hypodysplastic kidney and ectopic ureter associated with bicornuate uterus. A strong family history of uterine malformations prompted the examination of the uterus. Genetic testing was suggested but the family declined. She is planned to be referred to a gynecologist at puberty for further assessment. The recognition and screening rate of concurrent Mullerian anomalies in CAKUT patients varies between institutions. Screening for Mullerian anomalies in prediagnosed CAKUT girls may enable to provide timely counseling and to prevent gynecological complications.
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Abstract

Congenital anomalies of the kidney and urinary tract (CAKUT) are frequently associated with Mullerian anomalies. This can be explained by the fact that Mullerian duct elongation depends on the preformed Wolffian duct during embryogenesis. While CAKUT such as unilateral renal agenesis and multicystic dysplastic kidney are commonly identified prenatally by routine ultrasound, the diagnosis of Mullerian anomalies is often delayed, increasing the risk of complications such as endometriosis or pelvic inflammatory disease. Herein, we report a case of a premenarchal girl who had initially been diagnosed with right multicystic dysplastic kidney. She presented with continuous urinary incontinence at 4 years old and further evaluation by contrast-enhanced computed tomography, cystoscopy, colposcopy, ureterography, and hysterosalpingography led to the final diagnosis of right hypodysplastic kidney and ectopic ureter associated with bicornuate uterus. A strong family history of uterine malformations prompted the examination of the uterus. Genetic testing was suggested but the family declined. She is planned to be referred to a gynecologist at puberty for further assessment. The recognition and screening rate of concurrent Mullerian anomalies in CAKUT patients varies between institutions. Screening for Mullerian anomalies in prediagnosed CAKUT girls may enable to provide timely counseling and to prevent gynecological complications. Similar content being viewed by others

References

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Acknowledgements

We gratefully acknowledge the hospital staff for their help and support. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors have declared that no conflict of interest exists. Human and animal rights statement This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent Informed consent was obtained from the patient’s parents. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. About this article Cite this article Nakamura, M., Kanda, S., Kajiho, Y. et al. A case of right hypodysplastic kidney and ectopic ureter associated with bicornuate uterus in a prepubertal girl. CEN Case Rep 12, 122–129 (2023). https://doi.org/10.1007/s13730-022-00730-1 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13730-022-00730-1

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Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus Bicornuate Uterus

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