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Int Urogynecol J (2010) 21:365369 DOI 10.1007/s00192-009-0952-4
CASE REPORT
Blind hemibladder, ectopic ureterocele, or Gartners duct cyst in a woman with Mllerian malformation and supposed unilateral renal agenesis: a case report
Pedro Acin & Maribel Acin & Jess Romero-Maroto
Received: 3 March 2009 /Accepted: 21 June 2009 /Published online: 14 July 2009 # The International Urogynecological Association 2009
Abstract Genital anomalies associated with unilateral renal agenesis are generally due to agenesis or hypoplasia of the entire urogenital ridge or distal mesonephric aberrations. However, renal adysplasia could also occur in association with anomalies of the ventral urogenital sinus. The patient presented didelphys uterus in the superior uterine segment, a septate cervix, and a simple vagina. After transvaginal puncture and injection of a contrast agent into the bulge observed in the right vaginal wall, a filled sac or cavity was detected, possibly a hemibladder. This structure continued upward with a possible dilated tortuous ureter that filled retrogradely. Magnetic resonance imaging also showed the presence of the right blind paravaginal sac. Right hemitrigone and ureteral orifice were absent in the cystourethroscopy. No right kidney was found, despite the use of multiple imaging techniques. Blind hemibladder, ectopic
ureterocele, and Gartners duct cyst seem to be a possible diagnosis associated to Mllerian malformations and supposed unilateral renal agenesis. Therefore, Mllerian anomalies without combined mesonephric alteration could be associated with conditions of the ventral urogenital sinus, including blind hemibladder or ectopic ureterocele with secondary renal dysplasia.
Keywords Unilateral renal agenesis .
Female genital malformations . Mllerian anomalies . Ectopic ureterocele . Hemibladder . Gartners duct cysts
Introduction
According to previous studies [1, 2], unilateral renal agenesis is embryologically associated with genital, and sometimes extragenital, malformations. The associated genital malformations are due to agenesis of all derivatives of the ipsilateral urogenital ridge (with a unicornuate uterus on the other side) or distal mesonephric anomalies. An alternative embryologic sequence resulting in unilateral renal agenesis without Mllerian anomalies could be an involution or secondary renal atrophy. In other cases presenting with Mllerian anomalies but probably without mesonephric aberrations, there can also be atrophy or severe secondary renal adysplasia when the Mllerian anomaly is associated with anomalies of the cloaca/ urogenital sinus. Table 1 shows the adult derivatives and male and female abnormalities of...