Double ureter and duplex system have potential for future complications, such as the collecting system obstruction, lithiasis, ureterocele and vesicoureteral reflux.3 The early detection of the anomalies are helpful in avoiding complications related to the duplex collecting system. The patient underwent a right lower pole bilaterally. The operation was successfully done in a 49-year-old Thai female presented with a full staghorn kidney stone in the lower moiety of the duplex right kidney. Bisset 3rd GS, Strife JL. Ectopic ureters are commonly associated with a double (duplex) collecting system. Excretory urographic findings are almost always diagnostic. Aim . Bifid ureter is one of the variations related to … Duplex kidney is a developmental condition in which one or both kidneys have two ureter tubes to drain urine, rather than a single tube. The most common ureteric anomaly is that of ureter number, such as a duplex renal collecting system . The kidneys filter the blood and move waste into the urine. Happen with a single ureter or a double ureter (duplex collecting system). Duplex kidney is a developmental condition in which one or both kidneys have two ureter tubes to drain urine, rather than a single tube. Duplex kidney, also known as duplicated ureters or duplicated collecting system, is the most common birth defect related to the urinary tract. Vesicoureteral reflux (VUR) occurs when urine in the bladder flows back into one or both ureters and often back into the kidneys. Some of these anomalies are associated with a wide variety of other congenital genitourinary tract abnormalities and have been … A duplicated kidney, also referred to as an ureteral duplication or duplicated collecting system, means that a kidney has two ureters draining the kidney rather than the normal one. According to anatomic variation, the surgical treatment strategy is highly individualized. Complete duplication is most often associated with vesicoureteral reflux, ectopic ureterocele, or ectopic ureteral … Numerous congenital anomalies involving the kidney, ureter, and bladder have been described with a duplex collecting system, essentially the duplex ureter, in particular, being the most common anomaly with a reported incidence of 0.8%. duplex kidney in IVU].If the upper pole system has only poor kidney function, imaging with urography may miss the upper portion of the duplex kidney.A non-contrasting upper portion should be suspected if the number of calyces is reduced or by a … When a diagnosis of a duplicated collecting system is made prenatally, neonatal evaluation is important, as these individuals are prone to reflux, obstruction, and urinary tract infection. Duplication of the renal collecting system, also termed duplex kidney, is one of the few renal anomalies more common in females. There are considerable variations among patients, including anatomic variation, degree of VUR, functional disparities between the renal moieties, and presence or absence of UTIs; therefore, the surgical management of this entity is complex. Happen with or without Vesicoureteral reflux (VUR) (urine flowing back to the kidneys). The presence of an ectopic ureter may be indicated by continuous wetting, despite a normal voiding pattern, especially in girls. Transl Androl Urol. Duplex renal system is a general definition congenital pelvicaliceal systems, associated with incomplete, partial abnormality of the urinary tract characterized by partial or total duplication of the collecting system and renal pelvis and parenchyma [4]. Happen on both sides, from both kidneys (bilateral ureterocele). Duplex systems that have these complications also have ultrasound (US) findings that facilitate their prenatal detection. There is no harm to the kidney, though some people with duplex kidneys are more prone to urinary infections, reflux and blockages of the urinary tract. When … Duplex kidneys may be associated with ureterocele, ectopic ureter insertion or vesicoureteric reflux (VUR). Clinically significant duplication of the collecting system may manifest prenatally with upper pole hydronephrosis and dilatation of the upper pole ureter, lower pole hydronephrosis, or a ureterocele within the bladder. 2017;11(12):8-15. However, pelvo-ureteric junction obstruction in a duplex kidney is a rare finding. Duplex kidney, also called duplicated collecting system, occurs in about 1 percent of children and usually requires no medical treatment. Duplex collecting system is presence of complete or partial double pelvicalyceal system which is associated with single or double ureter. Duplex kidneys can occur in one or … Patients usually present in childhood with recurrent UTIs, flank pain, incontinence and hematuria [ 20 ]. Studies have reported that only 0.3% of patients have bilateral duplicated kidneys by excretory urography ( 7 ). Prenatal imaging features and postnatal outcomes of isolated fetal duplex renal collecting system: A systematic review and meta-analysis Francesca Bascietto, Asma Khalil, Giuseppe Rizzo, Alexander Makatsariya, Danilo Buca, Claudia Silvi, Matteo Ucci, Marco Liberati, Alessandra Familiari, Francesco D'Antonio A duplex kidney is where a child is born with a double kidney on one side (“duplex” is Latin for “double”). Ureteropelvic obstruction is more common when a duplex kidney exists and can be inherited in an autosomal dominant pattern. Ureterocele is rare especially with collecting system duplication in the nonorthotopic (extravesical) position in adult. Here, we report a case in which a middle age patient has bilateral duplex urinary collecting systems and horseshoe kidney deformity accompanied with right renal ureteral calculi and hydronephrosis. However, diagnosis can be made in rare instances during adulthood when duplex collecting systems are usually found incidentally on abdominal imaging or during surgery [ … Duplex kidney may result in urine flowing back into the kidney rather into the bladder and also may cause obstruction of urine. The most common complication was upper moiety obstruction (69/136, 81%), 67/69 (97%) of which were associated with a ureterocele. In 90% of girls with an ureterocele, the problem is from this. Happen on both sides, from both kidneys (bilateral ureterocele). In most cases, an ectopic ureter is associated with a duplex collecting system and complete ureteral duplication. Non contrast CT can detect renal stones and nephrocalcinosis. Physicians should keep such developmental abnormalities in mind and proceed to prompt investigation and management. Conclusion: Duplex collecting systems are common but clinically insig-nificant. Uretero-inguinal hernias have been reported as a common complication of renal transplant. It is often associated with a division of the kidney into two parts, an upper and lower lobe. Duplication may be either complete or incomplete and is often accompanied by various complications. Francesca Bascietto, Francesca Bascietto. In this study, complete duplication showed higher incidence of ectopic ureter and surgical intervention was needed. The management of reflux into duplex kidneys, ectopic ureters and ureteroceles will then be discussed. Cross sectional imaging include computed tomography (CT) and magnetic resonance imaging (MRI) help in resolving the complex anatomy, ectopic kidneys not detected on US, duplex collecting system, preoperative evaluation in PUJO and to look for complications like pyelonephritis, renal stones, and malignancies. The more extensive duplication, however, does often cause problems and can typically mean a child is more prone to urine infections. Duplication occurs when two separate ureteric buds arise from a single Wolffian duct [].Based on the degree of fusion, it can present as bifid renal pelvis, partial ureteric duplication, incomplete ureteric duplication with ureters joining near or in bladder wall, and complete ureteric … Duplex collecting system, also known as double ureters, happens to be one of the most … Obstruction of urine. A 19-year-old girl with a history of pulmonary tuberculosis (TB) as a young child presented with a complaint of increasing frequency of micturition, nocturia, urgency, and urge incontinence starting at the age of 17. 6,7 We illustrate our robotic technique of urinary tract reconstruction. It can be a complete split from the pyelocalicea to the ureteral orifice in the bladder, also called total duplication or pyelo ureteral duplicity. Non contrast CT can detect renal stones and nephrocalcinosis. Duplex collecting system diagnosed during the first 6 years of life after a first urinary tract infection: a study of 63 children Duplications of the renal collecting system and ureter are the most common congenital renal anomalies and can be classified as incomplete versus complete, depending on whether two ureters drain into the bladder via a single common ureter or separately. Methods Interval laparoscopic ureterolithtomy was carried out following placement of a percutaneous … However, uretero-inguinal hernias in native kidneys are considered an uncommon finding, especially with a duplex collecting system. Two conditions related to duplex kidney that can result in obstruction of urine flow are ureterocele and an ectopic ureter. It was diagnosed by magnetic resonance urography … A new classification of duplex kidney based on kidney morphology and management.Chin Med J (Engl). she also had a ureterocele which caused the urine to back up into the ureter and eventually killed off 1/2 her right kidney. Image in medicine A duplex collecting system, or duplicated collecting system, is one of the most complex congenital urinary tract malformations. Although CDS and IDS were accompanied by VUR more often than were single systems, CDS were associated more often with severe VUR, other serious complications and poor renal function. J Radiol Case Reports. The renal parenchyma may be divided into upper and lower components by a septum of Bertin, which is associated with a bifid collecting system and two renal pelvises. CT urography is useful in duplex system, their complex course, distal opening and associated other genitouri-nary malformations. Keywords: Cystoscopy • Ureterocele • Complications • Surgery Introduction A ureterocele is basically a cystic dilatation of the distal ureter, a challenging clinical situation because of variance in anatomy and presenting symptoms [1,2]. 80-93% are unilateral (1,2), the upper segment is involved in 85% of cases, and ureterocele is present in 24-47% of cases (3-5). A bilateral duplex collecting system is an unusual renal tract abnormality. Causes are unclear but may be genetic. Ureterocele is a congenital abnormality in the terminal ureter. A DCS usually shows a prolonged delay excretion on CTU because of the malfunction to secrete contrast to the duplicated ureters. The limited duplex kidney (where only the collecting system is double) is usually an incidental finding and rarely causes problems. This is a birth defect and is usually found in childhood. We review this unusual anomaly in terms of presentation, diagnostic evaluation, and surgical management. Endoscopic treatment was performed to decompress hydroureteronephrosis. Ureteroceles can be associated with single or duplex collecting systems. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Ureteropelvic Duplications In a normal urinary tract, each kidney is connected to one ureter (a tube that drains urine into the bladder). A 27-year-old male patient who underwent renal transplantation in 2017, on 19 April 2018, was presented with a creatinine level of 2.2 mg/dl. Or, the two ureters may unite before emptying into the bladder and define then the … The exact nature depends on the type of system involved as for example reflux associated with partially duplicated systems is ureteroureteric reflux and complete duplicated systems is usually associated with vesicoureteric reflux. Duplex collecting systems is the main topic and how it may become complicated by vesicoureteral reflux (VUR) and ureterocele will be covered in this paper. The duplex collecting system in girls with urinary tract infection: prevalence and significance. Duplex collecting system is presence of two pelvicalyceal system which is associated with single or double ureter. Duplex kidney, also called duplicated collecting system, occurs in about 1 percent of children and usually requires no medical treatment. In these cases, the double collecting system is thought to result from duplication of the ureteric bud.… with ectopy associated with duplex system, 80 percent of the contralateral system is also duplicated ; Impalpable testes; Ureterovaginal…. Ma R, Wu RD, Liu W, Wang G, Wang T, Xu ZD, Yu QH, Guo ZY. VUR is graded according to severity from grade 1 (mild) to grade 5 (severe). 3 Duplex-system ureteroceles are associated with kidneys that have completely duplicated ureters. ›. Duplex collecting system pathology can be handled using an ablative procedure or reconstructive procedure even in the light of a poorly functioning moiety. Urine leaks elsewhere in the collecting system usually develop secondary to ischemia, with resulting necrosis of the collecting system that is either limited to a small area or involves the entire ureter. Single-system orthotopic ureteroceles appear to respond most definitively with this approach. The limited duplex kidney (where only the collecting system is double) is usually an incidental finding and rarely causes problems. The more extensive duplication, however, does often cause problems and can typically mean a child is more prone to urine infections. The symptom of right flank pain was aggravated 5 days before admission. The majority of duplex abnormalities are asymptomatic and carry no clinical significance.3 Duplex kidneys can however be associated with complications. Different Classifications Used For Severity and Nature of Ureterocele Duplication occurs when two separate ureteric buds arise from a single Wolffian duct. These two ureters can drain independently into the bladder or connect and drain as a single ureter into the bladder. Intravenous urography: A duplex kidney is often an incidental finding during the diagnostic work-up for other diseases [fig. MP3-6. Ureteropelvic junction obstruction (UPJO) is rarely associated with a duplex collecting system. fusion anomalies), collecting systems (du-plex collecting system, megacalycosis, pel-viureteric junction obstruction [PUJO], and complications related to duplex collecting system), ureters (megaureter, retrocaval ure-ter, ectopic insertion, and ureterocele, the latter two pertaining to both single and du-plex systems), and the urinary bladder and Collecting System Complications. The part of the kidney that is duplicated is usually the collecting system (or renal pelvis), which is where urine collects before it is passed into … URETEROCELE WITH BILATERAL DOUBLE COLLECTING SYSTEM: A CASE REPORT. Pelvo-ureteric junction obstruction and duplex kidney are common radiological findings. Ureterocele is dilated cystic mass in the intravesical ureteral segment may be associated with a single or duplex system. Ureteroceles can be associated with single or duplex collecting systems. A duplex collecting system often causes no symptoms and may only be noticed during pregnancy when routine ultrasound examination shows fetal hydronephrosis. Happen with a single ureter or a double ureter (duplex collecting system). Most people do not need treatment. Result . Duplex kidney at a glance. detected on US, duplex collecting system, preoperative evaluation in PUJO and to look for complications like pyelonephritis, renal stones, and malignancies. A normal ureter travels 25–30 cm from the kidney to the bladder and is divided into three regions—ureteropelvic junction (UPJ), ureterovesicular junction (UVJ), and the point of crossing over the common iliac arteries [ 3 ]. Learning points Developmental anomalies of the kidney, ureter This chapter will discuss the terminology, incidence, embryology and pathophysiology of duplex kidneys. How is a duplex kidney treated? The two ureters may either drain the kidney into the bladder independently of one another or as a single ureter into the bladder. calyceal system is included as a variant ofa duplex system, 20families (66%) hadaffected first-degree relatives. Laparoscopic ureterolithotomy can provide a safe and successful alternative to these and open, invasive procedures. Recognising these patients early is important as severe complications are symptomatic and … We retrospectively reviewed the medical records of patients diagnosed with a duplex system with UPJO. Children with a duplex kidney (also called a duplicated collecting system) have two ureters coming from a single kidney. The patient had a complete duplex collecting system renal function. No treatment is needed. Duplex Collecting System. A case report of duplex collecting system of kidneys with ectopic ureter opening into the posterior urethra was reported by Snjezana Milicevic et al. However, diagnosis can be made in rare instances during adulthood when duplex collecting systems are usually found incidentally. Johnston reviewed clinical series of 73 children with complete or incomplete duplication and of nine cases in which the abnormality was a post-mortem finding [9]. A duplex renal system, ectopic ureterocele location, or preoperative reflux suggests trigonal anatomic distortion, increasing the likelihood of a … Prenatal diagnosis fetal duplex renal system is rare. A duplex collecting system can result in frequent urinary tract infections, backflow of urine into the kidney, and sometimes kidney damage. Your browser does not support HTML5 video. Clinically significant duplication of the collecting system may manifest prenatally with upper pole hydronephrosis and dilatation of the upper pole ureter, lower pole hydronephrosis, or a ureterocele within the bladder. [8]. Ureterocele has a variety of clinical manifestations and complications. 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