Ectopic ureteral insertion and megaureter with absence of ureteral orifice is a rare urinary tract malformation usually diagnosed in childhood. We present the case of an adult male with lower urinary tract obstructive symptoms secondary to right megaureter with ectopic insertion.

A 19-year-old male with one month of urinary difficulty. There is evidence of a distended bladder on physical examination. A uroflowmetry test reveals a flat curve morphology with a maximum flow of 3 ml/s and a post- void residual (PVR) volume of 400ml. Urethrocystoscopy is performed, revealing no urethral pathology, after ruling out urinary tract infection (UTI) and sexually transmitted infection (STI). A structure occupying space of 5 cm is identified in the bladder, protruding from the right lateral aspect to the bladder neck, which appears to exert extrinsic compression and exhibits obstructive behavior. The right ureteral orifice cannot be visualized. Due to the significant PVR, bladder catheterization is performed, and the patient is trained for clean intermittent catheterization. CT and MRI scans reveal right renal hypoplasia and a right megaureter with ectopic insertion, causing indentation on the posterior bladder wall without communication with it.

A laparoscopic right nephroureterectomy is performed after prior tutelage of the left uréter with DJ stent. The patient is placed in the left lateral decubitus position. A right-sided colonic mobilization and Kocher maneuver are executed. The megaureter is visualized and dissected until the renal pedicle is identified and clamped separately using Hemo-o-lok clips. The megaureter is released until the posterior bladder wall without observing communication with it (suggesting a blind cul-de-sac). After its release, a cystorrhaphy is performed through of a small vesical opening due to limited dissection plane. The surgical specimen is extracted in a laparoscopic bag through a right pararectal incision. The postoperative course is uneventful. The patient is discharged on the second day, and the bladder catheter and DJ stent are removed two weeks later. At one month follow-up, the patient is asymptomatic, without the need for clean intermittent catheterization. Follow-up uroflowmetry reveals a normal curve with a maximum flow of 18 ml/s and no significant post-void residual volume.

The acute urinary retention in young men should be thoroughly studied. Although the presented case is a rare and infrequent malformation as a cause of urinary obstruction, it should be considered as a condition that can lead to voiding difficulty.