Case of Unilateral Duplicated Ureter With Uterine Didelphys During Laparoscopic Hysterectomy

INTRODUCTION: Renal tract anomalies are rare, although are seen more frequently with müllerian abnormalities. Although congenital absence of a kidney is more frequently seen with uterine didelphys, a duplicate or aberrant ureter can also be seen and is important to identify during gynecologic surgery to avoid ureteral injury. OBJECTIVE: The purpose of this video is to demonstrate anatomical variants in renal tracts that could be seen during gynecologic surgery for müllerian anomalies. METHODS: This video was recorded with patient consent during a hysterectomy for postmenopausal bleeding. The procedure was a total laparoscopic hysterectomy, which was completed using five 5-mm incisions on the abdomen. RESULTS: A unilateral duplicate ureter was identified during a laparoscopic hysterectomy for a patient with a known müllerian anomaly. CONCLUSIONS: A high clinical suspicion for renal tract anomalies is necessary prior to gynecologic surgery for patients with müllerian anomalies to avoid injury. For patients with expected distorted anatomy, such as in endometriosis or prior pelvic surgery, ureteral stent placement can be considered.