Bladder agenesis is an extremely rare congenital anomaly of the genitourinary tract. Two female patients with known diagnoses of bladder agenesis presented for prerenal transplant evaluation and neobladder creation. Similar unique pelvic arterial malformations were identified through preoperative imaging and intraoperative examination. With these similar findings, it could be proposed that such anatomical variants are products of the same insult or involve a causal relationship, with vascular aberrancies potentially provoking pelvic organ maldevelopment. We advocate detailed mapping of the pelvic arterial tree preoperatively in bladder agenesis cases to prevent arterial injury and to safely delineate anatomy for appropriate transplant placement.
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