Increased Risk of Postoperative Hydroureteronephrosis in Patients With Comorbid Cystitis Glandularis, Pelvic Lipomatosis and Single-System Ectopic Ureter: Report of Three Cases.

BACKGROUND

Cystitis glandularis (CG) frequently coexists with pelvic lipomatosis (PL). However, the simultaneous presence of a single-system ectopic ureter (SSEU) has not been previously documented. This anatomical triad results in unusual bladder anatomy and obscured ureteric orifices, potentially increasing the risk of postoperative ureteric obstruction following transurethral resection procedures.

METHODS

Three patients with confirmed comorbid CG and PL (CG/PL) underwent transurethral resection of cystitis glandularis (TUR-CG) for persistent lower urinary tract symptoms. An SSEU was identified intraoperatively in all cases. Postoperative imaging and clinical outcomes were reviewed, with particular emphasis on the risk of hydroureteronephrosis. Informed consent was obtained from all patients.

RESULTS

All patients developed new-onset hydroureteronephrosis within months of TUR-CG despite normal preoperative uppertract imaging. Two required ureteric reimplantation owing to recurrent infection or stent-related stricture. The coexistence of CG, PL, and SSEU resulted in concealed or non-orthotopic ureteric orifices. This increased the likelihood of inadvertent orifice involvement during TUR-CG and complicated subsequent reconstructive surgery.

CONCLUSIONS

CG/PL, when complicated by unrecognised SSEU, represents a high-risk anatomical configuration in which TURCG may precipitate premature ureteric obstruction. Thorough preoperative imaging, surgical awareness of aberrant ureteric anatomy, careful consideration of surgical indications, and patient counselling are essential for minimising postoperative hydroureteronephrosis and anticipating technical challenges during subsequent ureteric reconstruction.