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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 1  |  Page : 87-89
A Case of Bladder and Colonic Duplication


1 Department of Urology, Karapitiya Teaching Hospital, Galle, Sri Lanka
2 Department of Radiology, Karapitiya Teaching Hospital, Galle, Sri Lanka

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   Abstract 

Duplication of the bladder is a rare congenital anomaly with an unknown embryological basis. A 12-year-old boy with dysuria was found to have a tri-radiate external urethral meatus instead of a vertical slit. Cystourethroscopy revealed two bladders with bifid proximal urethra. Magnetic resonance imaging (MRI) revealed duplication of colon and bladder. He did not have any symptoms related to the urinary tract.

Keywords: Bladder duplication, colonic duplication, congenital abnormalities

How to cite this article:
Abeygunasekera AM, Fathiehu F, Duminda M T, Jayasinghe R. A Case of Bladder and Colonic Duplication. Saudi J Kidney Dis Transpl 2008;19:87-9

How to cite this URL:
Abeygunasekera AM, Fathiehu F, Duminda M T, Jayasinghe R. A Case of Bladder and Colonic Duplication. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2014 Sep 3];19:87-9. Available from: http://www.sjkdt.org/text.asp?2008/19/1/87/37441

   Introduction Top


Duplication of the bladder is a rare conge­nital anomaly with an unknown embryological basis, and is usually a part of a complex anomaly. Because of the common develop­ment of the genitourinary and intestinal systems between the fifth and sixth gesta­tional week, anomalies that involve the cloaca frequently affect both systems. About 40% of the patients have duplication of the lower gastrointestinal tract. [1]


   Case report Top


A 12-year-old boy with dysuria was found to have a tri-radiate external urethral meatus instead of a vertical slit, but with a good urinary stream. A lower urinary tract anomaly was suspected. Abdominal ultrasonography suggested the presence of a large bladder diverticulum. Cystourethroscopy revealed two bladders with bifid proximal urethra. Mictu­rating cysto urethrogram (MCUG) confirmed the duplication of the bladder and the proxi­mal urethra [Figure - 1],[Figure - 2]. Magnetic reso­nance imaging (MRI) revealed duplication of colon and bladder [Figure - 3]. The patient did not have any symptoms related to the urinary tract. Nitrofurantoin was used as a prophylaxis and the patient has been symptom free for the one year of follow-up.


   Discussion Top


Bladder duplication can vary from an intra­vesical septum to complete duplication of the lower urinary tract. Complete duplication of the bladder involves two bladder halves, each with a full thickness muscular wall and each with its own ipsilateral ureteric orifice, half the trigone, and urethra. The double bladder is commonly a duplication in the sagittal plane, although cases of duplication in the coronal plane have been reported. [2] Incomplete dupli­cation consists of two bladder halves sepa­rated by a thick muscular wall both of which drain into a common urethra.

Embryological formation of bladder dupli­cation is not clear though several theories have been proposed. [3] Complete bladder duplica­tion is associated with a duplicated urethra, and in 90% of cases duplicated external geni­talia. [4] It differs from a bilocular bladder in which the bladder is divided by a septum without a muscular wall. Congenital bladder diverticulum is a rare anomaly that arises as a result of herniation of the bladder mucosa through the detrusor muscle. The wall of the diverticulum is thin and contains bladder mucosa surrounded by thinned muscle and adventitia.

The clinical significance of lower urinary tract duplication is not clear. Patients may complain of incontinence, recurrent infec­tions, and bladder outlet obstruction, how­ever, they are mostly symptomless; some are discovered incidentally during voiding cysto­urethrography, while others are discovered on autopsy.

Bladder duplications do not always require surgical management. Intervention may be­come necessary to eliminate stasis and achieve continence. Ultrasonography or intravenous urogram (IVU) usually reveals associated upper tract abnormalities. If bladder function and drainage is satisfactory no treatment is necessary.

Most colonic duplications are asymptomatic and remain undiagnosed for years. If sympto­matic they present with intestinal obstruction, bleeding or constipation. In most cases, symptomatic colonic duplications are recog­nized and treated in early childhood. [5] Treat­ment, usually in the form of surgical resection, is reserved for symptomatic cases.

 
   References Top

1.Gearhart JP. Exstrophy, epispadias and other bladder anomalies. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology. Saunders: Philadelphia; 2002. p. 2136-96.  Back to cited text no. 1    
2.Oguzkurt P, Ozalevli SS, Alkan M, Kayaselcuk F, Hicsonmez A. Unusual case of bladder duplication: Complete duplication in coronal plane with single urethra and no associated anomalies. Urology 2006;68:1121 e1-3.  Back to cited text no. 2    
3.Woodhouse CR, Williams DI. Duplication of the lower urinary tract in children. Br J Urol 1979;51:481-7.  Back to cited text no. 3  [PUBMED]  
4.Bae KS, Jeon SH, Lee SJ, et al. Complete duplication of bladder and urethra in coronal plane with no other abnormalities: Case report with review of the literature. Urology 2005;65:388.e12-3.  Back to cited text no. 4    
5.Fotiadis C, Genetzakis M, Papandreai I, Misiakos EP, Agapitos E, Zografos GC. Colonic duplication in adults: Report of two cases presenting with rectal bleeding. World J Gastroenterol 2005;11:5072-4.  Back to cited text no. 5    

Top
Correspondence Address:
Anuruddha M Abeygunasekera
Urology Consultant, Karapitiya Teaching Hospital, Galle
Sri Lanka
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PMID: 18087131

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]

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    Abstract
    Introduction
    Case report
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    References
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