Renal dysplasia with the ipsilateral ectopic ureter mimicking abscess of the prostate

Abstract

Introduction. In males the ectopic ureter usualy drains into the prostate (50%). During ureteric developement a thin membrane (Chawalla?s membrane) separates the lumen of the ureter and the urogenital sinus at the point where the ureter joins the urogenital sinus. This membrane ruptures allowing urin to drain from the ureter to the urogenital sinus. The authors reported a case of renal dysplasia associated with ipsilateral uretral ectopia mimicking prostatic abscess. Case report. A subfebrile (37.3?C), 23-year-old patient, otherwise healthy, presented with persistent ascending perineal pain non-responsive to antibiotics and analgetics. Digitorectal examination (DRE) showed asymmetric prostate with a soft, tender, buldging left lobe suggestive of prostatic abscess. The diagnosis was suspected using transrectal ultrasonography (TRUS), but the picture of the anechoic tubular structure in the left lobe of the prostate with a proximal undefined extraprostatic extension and a caudal intraprostatic blind end was incoclusive for the definitive diagnosis of prostatic abscess. Magnetic resonance imaging (MRI) was ordered and definitive diagnosis of renal dysplasia associated with the ipsilateral ectopic ureter filled with inflamed content mimicking prostatic abscess was made. Transurethral incision/minimal resection of the distal, blindly closed end of left ectopic ureter was done. Endoscopic surgical treatment was sufficient for relief of clinical symptoms. The patient?s recovery was uneventful. Conclusion. To the best of our knowledge, a case of renal dysplasia with the ipsilateral ectopic ureter mimicking prostate abscess has not been reported so far. Cystic pelvic malformations in males may result from too craniall sprouting of the ureteral bud, with delayed absorption and ectopic opening of the distal end of the ureter.Uvod. Ektopicni ureter kod muskaraca obicno se drenira u prostatu (50%). Tokom razvoja uretera tanka membrana (Chawallia membrana) razdvaja lumen uretera i urogenitalni sinus na nivou spoja uretera i urogenitalog sinusa. Rupturom ove membrane dolazi do drenaze urina iz uretera u urogenitalni sinus. U radu je prikazan bolesnik sa renalnom displazijom i ektopijom ipsilateralnog uretera koji je otkriven u okviru diferecijalnodijagnosticke pretrage suspektnog apscesa prostate. Prikaz bolesnika. Supfebrilan (37,3?C) bolesnik star 23 godine, inace zdrav, zalio se na konstantan, intenzivirajuci bol u perineumu koji nije prolazio na antibiotsku i analgetsku terapiju. Digitorektalnim pregledom (DRP) nadjena je simetricna prostata sa mekim, osetljivim, izdignutim levim lobusom sto je izazvalo sumnju na postojanje apscesa prostate. Nacinjena je transrektalna ultrasonografija (TRUS), ali slika tubularne formacija u levom lobusu prostate sa proksimalno nedefinisanom ekstraprostaticnom ekstenzijom i kaudalnim slepo zatvorenim intraprostatickim krajem bila je inkonkluzivna za definitivnu dijagnozu apscesa prostate. Nacinjeno je snimanje magnetnom rezonancom (MRI) kada je i postavljena definitivna dijagnoza renalne displazije sa ipsilateralnim ektopicnim ureterom, ispunjenim inflamiranim sadrzajem koji daje laznu sliku apscesa prostate. Nacinjena je transuretralna incizija slepo zatvorenog distalnog kraja levog ektopicnog uretera. Endoskopsko hirursko lecenje bilo je dovoljno za prestanak tegoba. Oporavak bolesnika protekao je uredno. Zakljucak. Pregledom literature nismo naisli na prikaz bolesnika sa renalnom displazijom i ipsilateralnim ureterom koji oponasa apsces prostate. Cisticne malformacije u muskoj karlici mogu rezultirati kranijalno postavljenim ureteralnim pupoljkom, sa odlozenom apsorpcijom i ektopicnom prezentacijom donjeg dela uretera.