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Combined surgical treatment for localized prostate cancer and incidental ureteral duplication with ectopic ureter inserting into the prostatic urethra

It is extremely rare to encounter an ectopic ureter in an older man undergoing radical prostatectomy for prostate cancer. We report a 68-year-old Japanese man with high prostate-specific antigen (PSA) of 12.76 ng/mL. The patient was known to have a complete duplication of the right urinary system and ectopic ureter inserting into the prostatic urethra featuring a giant hydronephrosis in the upper pole kidney (Fig. 1a). An abdominal computed tomography scan using contrast medium did not show any excretion from the completely thin renal parenchyma. There were no apparent signs of infection or subjective symptoms, so the patient was followed under surveillance. To ascertain prostatic cancer, a transrectal needle biopsy of the prostate followed by metastatic work-up was carried out, resulting in the diagnosis of a localized prostatic carcinoma; well-differentiated adenocarcinoma, Gleason score 3 + 3 and cT2aN0M0. In accordance with the patient’s wishes, combined surgical treatment including radical prostatectomy and heminephrectomy was carried out. A right heminephrectomy under a minimum skin incision (6 cm) was first carried out using a technical procedure to shrink the giant hydronephrosis (Fig. 1b). A radical retropubic prostatetctomy was then carried out, followed by an intensive dissection of the hydroureter originating from the upper pole kidney. The ectopic hydroureter was recognized to run between the seminal vesicle and the bladder neck (Fig. 1c). An intravesical approach was included to prevent the normal part of the duplicated ureter from impairment during the dissection procedure by marking it with an indwelt splint catheter. Finally, the hydronephrotic upper pole and its enlarged ureter were removed en bloc. The slice sectioning of the resected specimens showed the