Complete urogenital duplication in an asymptomatic adult woman: diagnostic challenges and embryological considerations – a case report

Complete urogenital duplication is an exceptionally rare congenital anomaly resulting from disturbances during early embryologic development. Simultaneous duplication of both urinary and genital systems is extremely uncommon, particularly in asymptomatic adult patients [1, 2]. We report the case of a 20-year-old woman in whom complete duplication of the urinary bladder, urethra, and vagina was detected during preconception evaluation. The patient had been married for approximately two months at presentation and had not attempted conception prior to diagnosis. A complete gynecological examination could not be performed due to intolerance of speculum examination caused by dyspareunia. Pelvic ultrasonography raised suspicion of a duplicated urogenital system, and pelvic magnetic resonance imaging (MRI) demonstrated complete sagittal duplication of the urinary bladder with independent ureters, duplicated urethras, and duplicated vagina, suggestive of an associated Müllerian duct anomaly. Both kidneys were normal in position and morphology, with no evidence of upper urinary tract duplication or obstruction. The patient was evaluated by a multidisciplinary team, and surgical excision of the vaginal septum was planned for symptom relief. Complete urogenital duplication may remain clinically silent into adulthood. MRI plays a crucial role in accurate anatomical delineation, evaluation of the upper urinary tract, and exclusion of associated anomalies. Awareness of this rare entity is essential to avoid misdiagnosis and unnecessary intervention, particularly in asymptomatic patients.