Ureteral triplication is an extremely rare congenital anomaly, with just over 100 cases reported in the literature. Smith classified this anomaly into four types in 1946. However, variants that do not fit this classification present significant diagnostic and therapeutic challenges. We present the case of a 5-year-old female patient evaluated for recurrent febrile urinary tract infections. Investigations revealed a duplicated left collecting system with high-grade vesicoureteral reflux (VUR). Intraoperatively, a third, blind-ending ureter was unexpectedly identified within the same sheath, exhibiting a unique “rosary-bead-like” morphology not previously described in the literature. The patient was successfully treated with Politano-Leadbetter ureteroneocystostomy, preserving the blind-ending ureter alongside the two functional ureters. This case represents a unique variant of ureteral triplication that does not fit Smith’s original classification due to the absence of associated renal parenchyma and the specific morphology of the third ureter. We highlight the utility of detailed preoperative imaging and intraoperative assessment in managing such unclassifiable variants. Ureteroneocystostomy without excision of the blind-ending ureter is a viable option to avoid vascular compromise to the functional units.
Karlı et al. (Thu,) studied this question.