Management of Upper Moiety in Complete Duplex System / 대한비뇨기과학회지

ABSTRACT

PURPOSE: Our experience of upper moiety in the complete duplex system was retrospectively analyzed to determine its optimum management. MATERIALS AND METHODS: Between 1988 and 2003, 27 patients were treated with the complete duplex system. Fifteen patients had ureterocele (9 intravesical, 6 ectopic) and the other 12 had an ectopic ureter. In all cases, excretory urography, ultrasonography, voiding cysto-urethrogram (VCUG) and dimercaptosuccinic acid (DMSA) renal scan were performed. The initial treatment was performed using salvage (transurethral incision or ureteropyelostomy) or non-salvage procedures (upper pole nephrectomy or nephrectomy). The median follow-up was 30 (13-48) months. RESULTS: The 27 patients were divided into three groups based on the function of the upper moiety from the DMSA renal scan - or=15%; 11 patients (group C). In group A, upper pole nephrectomy was performed in 9 patients, a total reconstruction in 3 and a nephrectomy in 1. In group B, an upper pole nephrectomy was initially performed, with an ureteropyelostomy and transurethral incision (TUI). In group C, all patients received a transurethral incision as the initial treatment. The ipsilateral renal function was well conserved in the cases of upper pole nephrectomy, with no complications. Patients initially receiving salvage procedures showed a significant improvement and conservation of the ipsilateral renal function, but 4 patients required additional operative management due to moderate to severe vesicoureteral reflux (VUR), recurrent urinary tract infection and decreased renal function of the upper moiety. CONCLUSIONS: Salvage procedures are a preferable adequate therapeutic modality for the complete duplex system with a well conserved renal function.