ABSTRACT
Background: Duplex kidneys are common developmental renal anomaly with an incidence of 1% in healthy adult population.Adult individuals may present as non-functional moiety, calculus disease or an incidental finding. Duplex kidney is defined as a renal unit comprised of two pelvicalyceal systems. Based on the degree of fusion, it can present as bifid renal pelvis, partial ureteric duplication (Y-shaped ureter), incomplete ureteric duplication with ureters joining near or in bladder wall (V-shaped ureter) and complete ureteric duplication with separate ureteric orifices. The purpose of this study is to retrospectively review the various duplex kidney anomalies and associated pathology.Methods: This is a retrospective study, performed at Department of Urology, Gauhati Medical College Hospital, a tertiary centre, from September, 2018 to August, 2019. Preoperative imaging, plain intravenous urography or computed tomography intravenous urography was done.Results: 29 patients were diagnosed with variants of duplex kidney anomaly. It includes right side, left side and bilateral anomalies. Among all the patients 4 had incidental findings. 16 patients had associated renal or ureteral calculus. 5 patients had associated ureteropelvic junction obstruction while 1 patient had ureterovesical junction stricture. We found single patient in each group of duplex kidney anomaly associated with non-functional moiety with renal cell carcinoma, ureterocele with urothelial malignancy and horseshoe kidney with ureteropelvic junction obstruction respectively.Conclusions: Duplex kidney anomaly in most individuals is of no clinical significance. High index of suspicion along with good quality imaging can accurately detect specific anomaly and associated condition.
ABSTRACT
OBJECTIVE@#The purpose of surgical intervention for ureteral duplication is to decrease the risk ofinfections, preserve renal function and avoid bladder dysfunction. The objective of this study was todetermine if there is a difference in outcome between total reconstruction of the urinary tract, anupper tract approach, or a lower tract approach.@*MATERIALS AND METHODS@#The outcomes of partial nephrectomy, common sheath re- implantation, totalreconstruction and transurethral incision of ureterocele were pooled and compared against eachother. Primary outcome criteria included breakthrough infection, voiding dysfunction and need for asecond surgery. Procedural dependence of the primary outcomes for each surgery was analyzed usingChi square test. Odds ratio was then computed for each procedure with total reconstruction as thestandard. Logistic regression analysis of the odds ratio was done to determine statistical significance.@*RESULTS@#A total of 128 patients were included in the study. Breakthrough infection was seen in 18.8%of those who underwent partial nephrectomy, 23.8% of those who underwent re- implantation, 19.4%of those who underwent total reconstruction, and 46.4% of those patients who underwent TUI-U.Only 1 patient from the partial nephrectomy group and 1 patient from the total reconstruction groupexperienced voiding dysfunction. Of the 23 patients who underwent TUI-U, 5 (17.9%) needed asecondary procedure, while 3 from the partial nephrectomy, and none from the re-implantation andtotal reconstruction groups required re-operations. Analysis showed that breakthrough urinary tractinfection is dependent on the type of procedure. Using total reconstruction as the standard, the oddsratio for partial nephrectomy is 0.962, 1.302 for common sheath re-implantation and 3.611 for TUI-U. Logistic regression analysis showed statistical difference in the odds ratio of TUI-U and totalreconstruction.@*CONCLUSION@#Breakthrough infection is shown to be dependent on the procedure. TUI-U has a 3.6-foldhigher chance of breakthrough infection compared to total reconstruction, hence up to 18% of patientswho opt for TUI-U should be counseled regarding the need for a secondary operation. The odds ofbreakthrough infection in common sheath re-implantation and partial nephrectomy is not significantlydifferent from total reconstruction. No evidence was established regarding the dependence of re-operations and voiding dysfunction to the primary procedure.
ABSTRACT
PURPOSE: Ureteral duplication is a common urologic anomaly and early diagnosis may prevent irreversible renal damage. We thus aimed to evaluate the benefits of prenatal sonography in early detection. METHODS: We retrospectively studied 55 children with duplicated systems who were admitted to Severance Hospital, Yonsei University, Seoul, Korea from January 1998 to July 2003. RESULTS: The mean age at diagnosis was 2.3 years old. 89% of the children had complete duplicated ureter. 47% of the children visited the hospital with an initial complaint of abnormal prenatal sonographic findings. Among these patients, 70.8% had DMSA defects. The mean differential renal function(DRF) in the DMSA scan was 48.2% in the group diagnosed prenatally. In the postnatally-diagnosed group, DMSA defects were found in 67.7% patients and the mean DRF was 45.5%. CONCLUSION: In comparison with the past studies, the mean age at diagnosis is becoming younger, and the proportion of abnormal prenatal sonography as an initial complaint larger. Other clinical manifestations were similar. The difference of the renal damage between the prenatally diagnosed group and the postnatally diagnosed group was not statistically significant. A multi-center study may help to prove the importance of prenatal sonography in early diagnosis and treatment of ureteral duplication.
Subject(s)
Child , Humans , Diagnosis , Early Diagnosis , Korea , Retrospective Studies , Seoul , Succimer , Ultrasonography , UreterABSTRACT
PURPOSE: Ureteral duplication is a common urologic anomaly and early diagnosis may prevent irreversible renal damage. We thus aimed to evaluate the benefits of prenatal sonography in early detection. METHODS: We retrospectively studied 55 children with duplicated systems who were admitted to Severance Hospital, Yonsei University, Seoul, Korea from January 1998 to July 2003. RESULTS: The mean age at diagnosis was 2.3 years old. 89% of the children had complete duplicated ureter. 47% of the children visited the hospital with an initial complaint of abnormal prenatal sonographic findings. Among these patients, 70.8% had DMSA defects. The mean differential renal function(DRF) in the DMSA scan was 48.2% in the group diagnosed prenatally. In the postnatally-diagnosed group, DMSA defects were found in 67.7% patients and the mean DRF was 45.5%. CONCLUSION: In comparison with the past studies, the mean age at diagnosis is becoming younger, and the proportion of abnormal prenatal sonography as an initial complaint larger. Other clinical manifestations were similar. The difference of the renal damage between the prenatally diagnosed group and the postnatally diagnosed group was not statistically significant. A multi-center study may help to prove the importance of prenatal sonography in early diagnosis and treatment of ureteral duplication.
Subject(s)
Child , Humans , Diagnosis , Early Diagnosis , Korea , Retrospective Studies , Seoul , Succimer , Ultrasonography , UreterABSTRACT
Duplicated collecting system is one of more common malformations of the urinary tract. Incomplete duplication rarely causes clinical problem but complete duplication often accompany complication of varying degree. We herein analyze retrospectively 20 patients with duplication who admitted to Dept. of Urology, Seoul National University Hospital during recent 3 years. There are 5 patients under age of 15. Six were male, 14 female. Nine patients had complete, 10 incomplete duplication. In 1 patient complete and incomplete duplication were presented. Three patients had bilateral, 17 unilateral duplication. Common chief complaints flank pain, urinary incontinence with voiding, fever and hematuria. Five patients had urinary tract infection documented by urine culture. I.V.P. was performed in all cases. Four refluxes were found in 7 V.C.U., Four ectopic ureteral orifices were recognized in 3 patients by cystopanendoscopy but not identified in 2 patients. Associated abnormalities were 6 extravesical ectopic ureter, 4 hydronephrosis, 4 ureteral stone, 2 ureterocele, 2 vesicoureteral reflux and pyelonephritis in 3 patients. Various surgical interventions were necessary in 17 patients, resulted in relief of chief complains. But 4 out of 17 patients experienced persistent urinary tract infection.
Subject(s)
Female , Humans , Male , Fever , Flank Pain , Hematuria , Hydronephrosis , Pyelonephritis , Retrospective Studies , Seoul , Ureter , Ureterocele , Urinary Incontinence , Urinary Tract , Urinary Tract Infections , Urology , Vesico-Ureteral RefluxABSTRACT
Duplicated collecting system is one of more common malformations of the urinary tract. Incomplete duplication rarely causes clinical problem but complete duplication often accompany complication of varying degree. We herein analyze retrospectively 20 patients with duplication who admitted to Dept. of Urology, Seoul National University Hospital during recent 3 years. There are 5 patients under age of 15. Six were male, 14 female. Nine patients had complete, 10 incomplete duplication. In 1 patient complete and incomplete duplication were presented. Three patients had bilateral, 17 unilateral duplication. Common chief complaints flank pain, urinary incontinence with voiding, fever and hematuria. Five patients had urinary tract infection documented by urine culture. I.V.P. was performed in all cases. Four refluxes were found in 7 V.C.U., Four ectopic ureteral orifices were recognized in 3 patients by cystopanendoscopy but not identified in 2 patients. Associated abnormalities were 6 extravesical ectopic ureter, 4 hydronephrosis, 4 ureteral stone, 2 ureterocele, 2 vesicoureteral reflux and pyelonephritis in 3 patients. Various surgical interventions were necessary in 17 patients, resulted in relief of chief complains. But 4 out of 17 patients experienced persistent urinary tract infection.