Prolapsing ectopic ureterocele in a female neonate presented with acute kidney injury and septicemia: emergency surgical management

Ureterocele is a rare congenital anomaly of the urinary tract, with prolapse through the urethra representing an exceptionally rare presentation that can lead to significant complications if not promptly recognized and treated. This condition shows a marked female predominance and is frequently associated with duplex collecting systems. A female neonate with antenatally diagnosed bilateral hydroureteronephrosis presented on day 4 of life with fever and a urethral bulge. Initial evaluation revealed acute kidney injury (creatinine 185 µmol/L), leukocytosis (WBC 22.0 × 10^9/L), thrombocytopenia (platelets 33 × 10^3/µL), and bilateral hydroureteronephrosis (SFU Grade 3) with left-sided grade IV vesicoureteral reflux. After failed bedside management, emergency surgical intervention with cystoscopy and open incision and deroofing of the prolapsed ureterocele was performed. Postoperative course showed complete resolution of right hydronephrosis and mild improvement of left hydronephrosis by day 7. Blood cultures grew Enterobacter cloacae, which resolved with appropriate antibiotic therapy. Renal function normalized (creatinine 30 µmol/L) with adequate urine output (5-5.5 mL/kg/hr). The patient was discharged with normal renal function and maintained on continuous antibiotic prophylaxis. This case illustrates the potential severity of complications in neonatal prolapsing ectopic ureterocele and demonstrates the importance of prompt surgical intervention in achieving favorable outcomes. Emergency surgical management can successfully resolve acute kidney injury and septicemia, emphasizing the need for decisive intervention in complex presentations involving bilateral involvement and duplex systems.