Page 1 of 6 Challenges of Management of Duplex System Ureterocele in an 18-Year-Old Woman: A Case Report Abubakar Sadiq Muhammad* and Khalid Abdullahi Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria. ISSN: 2692-532X DOI: 10.33552/AUN.2021.02.000547 Annals of Urology & Nephrology Case Report Copyright © All rights are reserved by Abubakar Sadiq Muhammad This work is licensed under Creative Commons Attribution 4.0 License AUN.MS.ID.000547. Abstract Background: Ureterocele is a cystic dilatation of the intravesical part of the ureter. Duplex system ureterocele is rare and occur more in females. Patients usually present with recurrent abdominal pain and urinary tract infection. The diagnosis and the treatment of duplex system ureterocele in women may pose diagnostic and therapeutic dilemma. We report a case of duplex system ureterocele in a woman highlighting diagnostic and therapeutic challenges. Case report: This is 18-year-old woman who presented with recurrent right flank pain, intermittent fever of 7months duration and lower urinary tract symptoms. There was right renal angle tenderness on abdominal examination. Abdominopelvic ultrasound and computerized tomographic scan urogram (CTU) revealed right hydronephrosis and a ureterocele. Accurate diagnosis was missed by all the imaging studies done. She had excision of the ureterocele and common sheath reimplantation of the two ureters on account of duplex system ureterocele. She had uneventful recovery. The urethral catheter, stents, drain and the stitches were remove 15 and 16 days postoperatively. She was discharged 20 days post operatively. Conclusion: Duplex system ureterocele may present with recurrent pyelonephritis. Computerized tomographic scan urogram is necessary for accurate diagnosis. There may be diagnostic and or therapeutic challenges. Common sheath ureteral reimplantation is associated with good outcome. Keywords: Duplex system; challenges; management; ureterocele; woman; cystic dilatation Abbreviations: CTU: Computerized Tomographic Scan Urogram; IVU: Intravenous Urogram; DMSA: Dimercaptosuccinic Acid Received Date: February 26, 2021 Published Date: March 24, 2021 *Corresponding author: Dr. Abubakar Sadiq Muhammad, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria. Introduction Ureterocele is cystic dilatation and outpouching of the intra vesical part of the ureter [1]. The incidence of ureterocele in the new born range from 1/500 to 1/4000 and female are affected 4-7times more than males [2]. Duplex system ureterocele occur in 1% of the population and in relation to upper moiety ureter in 80% of the cases [3]. Bilateral ureterocele occur in 10% of the cases [4]. When the diagnosis is missed in childhood, the patients may later present with recurrent infection, septicemia, stone and renal failure [5]. High index of suspicion is required for accurate diagnosis [5]. Embryologically, duplex system arises when 2 ureteric buds emerge from the distal part of mesonephric duct. The future lower moiety ureter separates from the Wolffian duct early and attaches to the future urinary bladder in the urogenital sinus superior laterally acquiring short intravesical course making it prone to reflux [1]. While the upper moiety ureteric bud separates lately from the mesonephric duct, therefore acquiring long intravesical course and draining into the urinary bladder inferior and medial to the lower moiety ureter [1]. The upper moiety ureter is associated with ectopia and ureterocele as postulated in the Weighert- Meyer rule [6]. However, Stephen described an exception to this rule [7]. Stephen’s ectopic pathway states that the ectopic ureter may not only insert distal to the normal ureteric orifice but may