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Case report
Novel approach to locating a hypoplastic kidney in a unique variant of uterine didelphys syndrome presenting with continuous incontinence
  1. Kathleen Rebecca Lockhart1,
  2. Megan Saul2 and
  3. Allison Blatt1
  1. 1Department of Urology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
  2. 2Department of Nuclear Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
  1. Correspondence to Dr Kathleen Rebecca Lockhart; klockhart19{at}


Mullerian abnormalities such as uterine didelphys have an association with renal abnormalities. Ureteric ectopia must be considered as a differential diagnosis of incontinence. We describe the case of a 21-year-old woman who presented with low volume continuous incontinence with a history of right renal agenesis and uterus didelphys. A right kidney was not identified on CT intravenous pyelogram but excretory phase images suggested the presence of a right ureter. Diethylenetriaminepentaacetic acid renogram confirmed an area of perfusion consistent with a poorly functioning right kidney remnant. Cystoscopic investigation demonstrated an orthotopic left ureteric orifice, and an ectopic right ureteric orifice was identified in the posterior fornix of the right vagina. A laparoscopic right nephrectomy was performed, with a new application of indocyanine green aiding in identification of the right hypoplastic kidney with fluorescence imaging. The patient recovered well postoperatively and experienced complete resolution of incontinence, with preserved normal renal function.

  • urological surgery
  • renal intervention
  • continence
  • urinary and genital tract disorders
  • surgical diagnostic tests

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  • Contributors AB clinically managed the presented case and oversaw the research and editing of the report. KRL performed the literature review and drafted the clinical case and discussion. MS provided some technical expertise and contributed to the discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.