[Ureteral triplication--a case report].
BACKGROUND
Of all children born with congenital anomalies, 30-40% have urogenital abnormalities. Most of them are asymptomatic, but if any symptoms occur, they are usually symptoms of urinary infections.


METHODS
A four-year old girl was admitted because of recurrent urinary infections and in order to perform a thorough clinical examination. Clinical examination showed an asymmetrical gluteus and presence of a fibroma in the same region. Detailed radiologic examinations (ultrasonography, plain X-ray, excretory urography, voiding urethrocystography) revealed a triplicate ureter on the right side with a vesicoureteral reflux of the fifth grade on the same side. Intraoperatively, type III ureteric triplication according to Smith's classification was established. Ureteral remodeling and reimplantation was done. The postoperative course was good, and follow-up voiding urethrocystography showed absence of reflux.


CONCLUSIONS
Ureteral triplication is a consequence of either development of three buds on the mesonephric duct, or development of two buds, one of which further divided into two parts. Most common anomalies associated with ureteral triplication are: ureteral duplication on the other side (37%), ectopy of the ureteric orifice (28%) and kidney dysplasia (8%). Vesicoureteral reflux is very common on affected or on both sides. Symptomatology is the same as in ureteral duplication--dominated by signs of urinary infections.


CONCLUSIONS
Diagnosis of ureteral duplication requires detailed imaging. Treatment of symptomatic abnormalities should be individual, regardless of the applied treatment (conservative or operative).
Zivković
Dragana
D
Medicinski fakultet Novi Sad, Institut za zdravstvenu zastitu dece i omladine, Klinika za decju hirurgiju. zdragana@eunet.yu
Varga
Jan
J
Grebeldinger
Slobodan
S
Borisev
Vladimir
V