Case report – duplex collecting system with ectopic ureter inserting into the prostatic segment of the urethra

Abstract: Congenital anomalies of the urinary tract include a broad range of variations, from subtle deviations to
complex structural malformations. Among these, duplex collecting systems are relatively common, identified in
roughly 0.7% of the population, while ectopic ureters are much less frequent, with a prevalence ranging between
0.025% and 0.05%. In male patients, ectopic ureters most often terminate in the prostatic urethra, seminal vesicles,
or vas deferens. Because such anomalies are frequently asymptomatic, they are often discovered incidentally during
imaging performed for unrelated reasons, which can make diagnosis particularly challenging. The purpose of this
case report is to describe the incidental detection of a duplex collecting system with an ectopic ureter inserting into
the prostatic segment of the urethra in a 36-year-old male. The patient was initially referred for computed
tomography urography after ultrasound demonstrated a dilated tubular structure suggestive of congenital
abnormality. CT urography confirmed the presence of a duplex system in the left kidney, demonstrating a markedly
dilated ectopic ureter, measuring up to 4.5 cm in diameter, that drained the upper pole calyx and descended distally
to the prostatic urethra. The findings were associated with severe calyceal distension, proximal urethral dilation, and
mechanical displacement of adjacent structures, including anterior displacement of the pancreatic tail and
impression upon the posterior bladder wall. In addition, dual arterial supply to the left kidney was demonstrated,
representing an additional anatomical variation relevant to surgical planning. The right kidney was unremarkable.
These results underscore the importance of advanced cross-sectional imaging in revealing both the collecting system
configuration and vascular anatomy, which are critical for diagnosis and therapeutic planning. Although many
collecting system anomalies remain without symptoms, the considerable dilation and impaired drainage observed in
this case highlight the potential for future complications, including infection, obstruction, or loss of renal function.
The conclusion drawn from this report is that detailed imaging plays a pivotal role not only in identifying rare
ureteral insertions but also in assessing their structural and functional impacts. Recommendations for practice
emphasize close monitoring in asymptomatic cases, interdisciplinary evaluation involving radiologists and
urologists, and early consideration of surgical correction if symptoms or progressive changes occur. Additional
elements of interest in this case, such as the dual renal arteries and mass effect on neighboring organs, illustrate that
congenital anomalies may extend their clinical relevance beyond the urinary tract alone. This case contributes to the
growing documentation of rare ureteral terminations in males and supports the importance of vigilant imaging
review for accurate detection and individualized management planning.
Keywords: ectopic ureter, anatomical ureteral variations, duplex collecting system, urinary tract anomalies, ectopic
ureter with prostatic urethral insertion