A Bilateral Primary Non-refluxing Non-obstructed Megaureter Presenting as Chronic Flank Pain in an Adult Female Patient: A Case Report

A primary megaureter is a congenital ureteral anomaly most commonly diagnosed in the pediatric population. Bilateral presentation in adults is exceptionally rare and poses a diagnostic challenge given the broad differential diagnosis of hydroureteronephrosis. A 56-year-old woman presented to the urology clinic with chronic intermittent bilateral flank pain. Computed tomography of the abdomen and pelvis confirmed bilateral hydroureteronephrosis with ureteral dilatation measuring 16 mm on the right and 11 mm on the left, with no obstructing lesion identified. Cystoscopy with bilateral retrograde pyelograms demonstrated bilateral ureteral and pelvicalyceal dilatation with free contrast drainage and no filling defects, excluding obstruction. A cystogram excluded vesicoureteral reflux. The diagnosis of a bilateral primary non-refluxing non-obstructed megaureter was established by exclusion. The patient was managed conservatively with six-monthly renal ultrasound surveillance and remained asymptomatic at follow-up. A bilateral primary non-refluxing non-obstructed megaureter is a rare but important diagnosis in adults presenting with hydroureteronephrosis. A systematic workup excluding obstruction and reflux is essential. Conservative management is appropriate in patients with preserved renal function and absent complications.