Proximal Ureteral Quadruplication In Combination With Ureteral Cyst: a case report.

Ureteral quadruplication is a very rare developmental malformation and it is sometimes associated with other congenital urinary tract abnormalities. This is the first case described in our country and in Africa, and apparently the 13 th worldwide. It concerns a 9 years old Black child of the male gender, with a history of distended and progressively painful abdomen. Six years ago, the patient was brought to the hospital for a painful abdominal mass associated with fever and cough. Fever and cough was finally found to belong to malaria and upper respiratory tract infection. In the CT-scan, the abdominal lump was reported to be a polycystic kidney in combination with ureterohydronephrosis. After a laparotomy indicated for this former condition, per operative diagnosis was that of a unilateral quadruplication of the right ureter, opened into a close proximal ureteral cyst. The distal monoureter opened into the bladder. Surgery of this malformation was conservative. It consisted of ureteral resection of its dilated proximal portion, and nephro-ureteral end to end anastomosis after ureteropyeloplasty. Post-operative outcome was marked by the fact that the child had clinically recovered from the previous symptoms and his paraclinic exams and laboratory tests were progressively satisfactory. In conclusion, in the presence of an abdominal mass associated with urinary tract signs in late childhood, the physician should also evoke ureteral malformation in his differential diagnosis. In terms of differential diagnosis, this case has a broad clinical impact across medicine because it is implicating both surgery (urology and pediatric surgery) and internal medicine (nephrology and medical oncology). In the other hand, renal conservative surgery is to be considered when the secretory function remains.