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Bladder

Congenital anomalies

Duplication


Reviewer: Alcides Chaux, M.D., Johns Hopkins University School of Medicine (see Reviewers page)
Revised: 8 April 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Bladder is separated into complete or incomplete compartments, either in the sagittal or coronal plane
● Variants include double bladder, septal bladder and hourglass bladder

Epidemiology
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● Rare, <100 cases reported
● Equal male:female ratio

Etiology
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● No single explanation for all cases of bladder duplication
● Complete duplication of bladder and hindgut probably occurs because of partial twinning of the tail portion of the embryo
● Excessive constriction of ventral cloaca or a supernumerary cloacal septum may lead to bladder duplication in the coronal plane
● Complete bladder duplication with diphalia may be explained by duplication of the cloaca

Clinical features
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● Varies from intravesical septum to complete duplication of lower urinary tract
● Complete duplication means two bladders, each with a full thickness muscularis propria and its own ipsilateral ureter, half the trigone, and a urethra; may occur in coronal or sagittal planes
● Sagittal duplication (the most common): each bladder receives the ureter of ipsilateral kidney, separated from the other by a peritoneal fold and loose areolar tissue, is more often associated with non-urological anomalies than coronal ones
● Coronal duplication: two bladders lying in front of each other, separated by an oblique (posterosuperior to anteroinferior) fibromuscular septum
● Incomplete duplication consists of two bladder halves separated by a thick muscular wall, both draining into a common urethra
● Associated with other GI (36-42%) and GU (38-90%) anomalies, including caudal duplication syndrome (Am J Dis Child 1993;147:1048)
● Anomalies (and treatment) may vary by patient (Urology 2000;55:578)
● Incomplete emptying may cause urinary tract infections, although most patients are asymptomatic

Case reports
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● 4 month old boy (J Pediatr Urol 2008;4:255)
● 15 month old boy with complete bladder duplication in the sagittal plane (Eur J Pediatr Surg 2009;19:410)
● 3 year old boy with no other anomalies (Urology 2006;68:1121.e1)
● 12 year old boy with bladder and colonic duplication (Saudi J Kidney Dis Transpl 2008;19:87)

Treatment
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● In some cases, needed for infections or to achieve continence

Clinical images
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Cystourethrogram shows complete bladder duplication


Ultrasound shows complete bladder duplication

End of Bladder > Congenital anomalies > Duplication


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