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Frontiers in Pediatrics 2019Robot-assisted laparoscopic (RAL) surgery is a safe, minimally invasive technique that has become more widely used in pediatric urology over recent decades. With several... (Review)
Review
Robot-assisted laparoscopic (RAL) surgery is a safe, minimally invasive technique that has become more widely used in pediatric urology over recent decades. With several advantages over standard laparoscopy, robotic surgery is particularly well-suited to reconstructive surgery involving delicate structures like the ureter. A robotic approach provides excellent access to and visualization of the ureter at all levels. Common applications include upper ureteral reconstruction (e.g., pyeloplasty, ureteropelvic junction polypectomy, ureterocalicostomy, and high uretero-ureterostomy in duplex systems), mid-ureteral reconstruction (e.g., mid uretero-ureterostomy for stricture or polyp), and lower ureteral reconstruction (e.g., ureteral reimplantation and lower ureter-ureterostomy in duplex systems). Herein, we describe each of these robotic procedures in detail.
PubMed: 30968006
DOI: 10.3389/fped.2019.00085 -
Archivos Espanoles de Urologia Dec 2022The objective of our study was to share the experience of the ectopic ureter and to characterize associated clinical features, medical images, and management.
BACKGROUND
The objective of our study was to share the experience of the ectopic ureter and to characterize associated clinical features, medical images, and management.
METHODS
A retrospective analysis was performed on 13 cases of ectopic ureter confirmed by surgery. The gender, age, abnormal urinary leakage, the site of the ectopic ureter, renal dysplasia, and surgical methods of the patients were compared and analyzed.
RESULTS
Eleven females and 2 males with ectopic ureters were analyzed. Eight cases had the clinical symptom of persistent or intermittent urine leakage since birth. One case was with complete persistent urine leakage, and 4 cases with no urine leakage. The site of the ectopic ureters was mostly unilateral. Ectopic ureters were located in the vagina in 6 cases, urethra in 4 cases, prostate in 1, and uncertain in 2 cases. There were 3 cases with ectopic kidney and renal atrophy, 3 cases had "Y" ureter, and 8 cases had repeated ureters with duplex kidneys. Twelve cases were treated with surgery, and 1 case underwent bilateral ureteral stent implantation. Three cases were complicated with ureteral stump syndrome after surgery.
CONCLUSIONS
The classic symptom of the ectopic ureter is continuous wetting with intermittent normal micturition in most young girl patients. Ectopic ureter is often associated with duplex kidneys, ectopic kidneys and atrophic kidneys. The surgical approach should be personalized. The aim of the surgery is to make the patient without urine leakage and preserve kidney function.
Topics: Male; Female; Humans; Ureter; Retrospective Studies; Kidney Pelvis; Ureteral Obstruction; Kidney Diseases; Kidney
PubMed: 36651090
DOI: 10.56434/j.arch.esp.urol.20227510.118 -
F1000Research 2020Congenital abnormalities of the kidney and urinary tract (CAKUT) are a highly diverse group of diseases that together belong to the most common abnormalities detected in... (Review)
Review
Congenital abnormalities of the kidney and urinary tract (CAKUT) are a highly diverse group of diseases that together belong to the most common abnormalities detected in the new-born child. Consistent with this diversity, CAKUT are caused by mutations in a large number of genes and present a wide spectrum of phenotypes. In this review, we will focus on duplex kidneys, a relatively frequent form of CAKUT that is often asymptomatic but predisposes to vesicoureteral reflux and hydronephrosis. We will summarise the molecular programs responsible for ureter induction, review the genes that have been identified as risk factors in duplex kidney formation and discuss molecular and cellular mechanisms that may lead to this malformation.
Topics: Child; Genetic Predisposition to Disease; Humans; Hydronephrosis; Kidney; Mutation; Vesico-Ureteral Reflux
PubMed: 32030122
DOI: 10.12688/f1000research.19826.1 -
Urology Journal 2011To study the prevalence of duplex system and double ureter in cadavers and intravenous pyelograms in Indian population.
PURPOSE
To study the prevalence of duplex system and double ureter in cadavers and intravenous pyelograms in Indian population.
MATERIALS AND METHODS
Fifty cadavers were dissected and 50 intravenous pyelograms were examined on both (right and left) sides for the presence of duplex system and double ureter.
RESULTS
One male cadaver aged 43 years showed complete double ureter and duplex system on the right side and incomplete double ureter and duplex system on the left side. Another male cadaver aged 56 years showed incomplete double ureter and duplex system only on the right side. An intravenous pyelogram of a 43-year-old man showed incomplete double ureter along with duplex system on the right side.
CONCLUSION
Developmental anomalies of the kidney, ureter, and urinary bladder should be kept in mind and promptly detected before the manifestations of aforementioned complications increase the morbidity of the affected individuals.
Topics: Adolescent; Adult; Aged; Female; Humans; Kidney Pelvis; Male; Middle Aged; Ureter; Urography; Young Adult
PubMed: 21656475
DOI: No ID Found -
The Pan African Medical Journal 2016
Topics: Gastrointestinal Diseases; Humans; Kidney Pelvis; Ureter
PubMed: 28292161
DOI: 10.11604/pamj.2016.25.204.9529 -
European Urology Open Science Nov 2023Duplex kidneys may be associated with additional pathologies with an indication for surgery. Various surgical approaches have been described. However, little is known...
Personalized Surgical Management Offers Full Restitution and Unimpaired Quality of Life to Patients with Duplex Kidneys and Associated Pathologies: 30-year Follow-up at a Tertiary Referral Center.
BACKGROUND
Duplex kidneys may be associated with additional pathologies with an indication for surgery. Various surgical approaches have been described. However, little is known about long-term outcomes and quality of life (QoL) for these patients.
OBJECTIVE
To present long-term outcomes and QoL data up to 30 yr after surgical treatment of duplex kidneys and associated pathologies.
DESIGN SETTING AND PARTICIPANTS
We collected clinical and operative data for all patients who underwent surgery for complicated duplex kidney at our institution from 1990 to 2018. All patients were invited for a follow-up examination or telephone interview.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
We evaluated renal function, clinical outcomes, residual dilation of the upper urinary tract, and health-related QoL.
RESULTS AND LIMITATIONS
Of the 176 patients included, 173 were available for follow-up (mean 140.5 mo). Surgical treatment involved an upper-tract, lower-tract, or combined approach in 11%, 56%, and 33% of cases, respectively. Rates of perioperative complications (8%) and secondary surgery (10%) were low. Overall, 95% of our patients achieved full restitution. Renal function was preserved in all cases, with recurrent urinary tract infections reported by just 2% and urinary incontinence by 1%. Good health-related QoL was reported by 98% of patients. Those without full restitution included six patients who underwent total nephrectomy and two boys who underwent multiple surgeries and urinary diversion. Our results are limited by their retrospective nature, including partly incomplete data sets.
CONCLUSIONS
Management of duplex kidneys and associated pathologies is complex and highly individual. By planning a personal approach for each patient it is possible to achieve full bodily integrity and good QoL for most of these patients.
PATIENT SUMMARY
Almost all patients undergoing surgery for duplex kidneys and associated pathologies will lead a life without body impairment and good quality of life.This trial is registered in the German Clinical Trials Register as DRKS00022542.
PubMed: 38020523
DOI: 10.1016/j.euros.2023.09.012 -
World Journal of Clinical Cases Aug 2022Duplication of the renal pelvis is a common congenital malformation of the urinary system. About one-third of cases are complete unilateral duplication of the renal...
BACKGROUND
Duplication of the renal pelvis is a common congenital malformation of the urinary system. About one-third of cases are complete unilateral duplication of the renal pelvis, while bilateral duplication is extremely rare. Herein, we described a single case of bilateral renal duplication with double ureteral orifice ectopic vaginal fistula treated with laparoscopy.
CASE SUMMARY
A 6-year-old girl suffering from long-term vaginal leakage was admitted on June 10, 2018. She was diagnosed with complete duplication of both kidneys and ureters and ectopic opening of both ureters combined with ureterovaginal fistula. The patient received laparoscopic ectopic ureteral bladder replantation and was followed up for 2 years. No renal function damage and vaginal leakage were found.
CONCLUSION
Laparoscopic bladder-ureter reimplantation could effectively determine the location and number of ectopic ureters by imaging and cystoscopy.
PubMed: 36159542
DOI: 10.12998/wjcc.v10.i23.8344 -
Cureus Jan 2020Duplex ureter, an embryological developmental anomaly, can lead to intra-operative injuries, even by surgeons with a stronghold on normal ureteric anatomy. We describe...
Duplex ureter, an embryological developmental anomaly, can lead to intra-operative injuries, even by surgeons with a stronghold on normal ureteric anatomy. We describe the first case of an ectopic ureter transected during vaginal hysterectomy performed for pelvic organ proplase, due to its abnormally low implantation into the bladder, worsened by cystocoele. The injury was recognised, and the duplex ureter was diagnosed with cystoscopy and retrograde pyelography. A post-operative computed tomography urogram allowed us to map the exact course. In this case, there was injury to the ectopic, non-functional ureter, thus averting any further intervention. However, lower urinary tract injuries are serious complications with high morbidity, especially during delayed diagnosis. Knowledge of the ureter variants, meticulous tracing of the course, and use of post-operative cystoscopy could reduce these complications, particularly in face of increasing minimally invasive approaches.
PubMed: 32064179
DOI: 10.7759/cureus.6597 -
International Braz J Urol : Official... 2021
Topics: Humans; Infant; Ureter; Ureteral Obstruction; Ureteroscopy; Vesico-Ureteral Reflux
PubMed: 33621010
DOI: 10.1590/S1677-5538.IBJU.2020.0742.1 -
International Urology and Nephrology Oct 2023The aims of this study were to analyze the clinical outcomes of treating duplex system ureteroceles with early endoscopic puncture decompression and to identify the risk...
Clinical outcomes and risk factor analysis of early endoscopic puncture decompression for ureterocele associated with duplex kidney in children: a single-center retrospective study.
PURPOSE
The aims of this study were to analyze the clinical outcomes of treating duplex system ureteroceles with early endoscopic puncture decompression and to identify the risk factors related to outcomes to help guide future work.
MATERIALS AND METHODS
We retrospectively reviewed the clinical records of patients with ureteroceles with duplex kidney that were treated with early endoscopic puncture decompression. Charts were reviewed for demographics, preoperative imaging, surgical indications, and follow-up data. Recurrent febrile urinary tract infections (fUTIs), de novo vesicoureteral reflux (VUR), persistent high-grade VUR, unrelieved hydroureteronephrosis, and the need for further intervention were considered unfavorable outcomes. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), type of ureterocele, ipsilateral VUR diagnosed before surgery, simultaneously upper-pole moiety (UM) and lower-pole moiety (LM) obstruction, the width of ureter affiliated to UM, and maximum diameter of ureterocele were all considered potential risk factors. A binary logistic regression model was used to identify the risk factors of unfavorable outcomes.
RESULTS
A total of 36 patients with ureteroceles related to duplex kidney underwent endoscopic holmium laser puncture from 2015 to 2023 at our institution. After a median follow-up of 21.6 months, unfavorable outcomes developed in 17 patients (47.2%). Three patients underwent ipsilateral common-sheath ureter reimplantation and one patient underwent laparoscopic ipsilateral upper to lower ureteroureterostomy combined with recipient ureter reimplantation. Three patients underwent laparoscopic upper-pole nephrectomy. Fifteen patients suffered from recurrent UTIs were treated with oral antibiotics and eight of them were diagnosed de novo VUR according to voiding cystourethrography (VCUG). In univariate analysis, patients with simultaneously UM and LM obstruction (P = 0.003), fUTIs before surgery (P = 0.044), and ectopic ureterocele (P = 0.031) were more likely to have unfavorable outcomes. Binary logistic regression analysis showed that ectopic ureterocele (OR = 10.793, 95% CI 1.248-93.312, P = 0.031) and simultaneously UM and LM obstruction (OR = 8.304, 95% CI 1.311-52.589, P = 0.025) were identified as independent factors for unfavorable outcomes.
CONCLUSIONS
Our study suggested that early endoscopic puncture decompression is not a preferred but an available treatment option to release BOO or to cure refractory UTIs. It was easier to fail if the ureterocele was ectopic or simultaneously UM and LM obstruction existed. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), ipsilateral VUR diagnosed before surgery, the width of ureter affiliated to UM, and maximum diameter of ureterocele were not significantly related to the success rate of early endoscopic punctures.
Topics: Child; Humans; Female; Pregnancy; Infant; Ureterocele; Retrospective Studies; Urinary Bladder Neck Obstruction; Kidney Diseases; Kidney; Vesico-Ureteral Reflux; Urinary Tract Infections; Risk Factors; Punctures; Laparoscopy; Decompression; Treatment Outcome
PubMed: 37393384
DOI: 10.1007/s11255-023-03694-y