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BMC Urology May 2016Duplex kidney is a common anomaly that is frequently associated with multiple complications. Typical computed tomography urography (CTU) includes four phases...
BACKGROUND
Duplex kidney is a common anomaly that is frequently associated with multiple complications. Typical computed tomography urography (CTU) includes four phases (unenhanced, arterial, parenchymal and excretory) and has been suggested to considerably aid in the duplex kidney diagnosi. Unfortunately, regarding duplex kidney with prolonged dilatation, the affected parenchyma and tortuous ureters demonstrate a lack of or delayed excretory opacification. We used prolonged-delay CTU, which consists of another prolonged-delay phase (1- to 72-h delay; mean delay: 24 h) to opacify the duplicated ureters and affected parenchyma.
METHODS
Seventeen patients (9 males and 8 females; age range: 2.5-56 y; mean age: 40.4 y) with duplex kidney were included in this study. Unenhanced scans did not find typical characteristics of duplex kidney, except for irregular perirenal morphology. Duplex kidney could not be confirmed on typical four-phase CTU, whereas it could be easily diagnosed in axial and CT-3D reconstruction using prolonged CTU (prolonged-delay phase).
RESULTS
Between January 2005 and October 2010, in this review board-approved study (with waived informed consent), 17 patients (9 males and 8 females; age range: 2.5 ~ 56 y; mean age: 40.4 y) with suspicious duplex kidney underwent prolonged CTU to opacify the duplicated ureters and confirm the diagnosis.
CONCLUSION
Our results suggest the validity of prolonged CTU to aid in the evaluation of the function of the affected parenchyma and in the demonstration of urinary tract malformations.
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Imaging, Three-Dimensional; Kidney; Male; Radiographic Image Enhancement; Reproducibility of Results; Sensitivity and Specificity; Time Factors; Tomography, X-Ray Computed; Ureter; Urography; Young Adult
PubMed: 27177584
DOI: 10.1186/s12894-016-0139-5 -
Frontiers in Pediatrics 2022Megaureter, described as ureter dilatation more than 7 mm in diameter, commonly associated with other anomalies, is still a diagnostic and therapeutic challenge....
INTRODUCTION
Megaureter, described as ureter dilatation more than 7 mm in diameter, commonly associated with other anomalies, is still a diagnostic and therapeutic challenge. Magnetic resonance urography (MRU) appears as a promising method in urinary tract imaging, providing both anatomical and functional information. There are several postprocessing tools to assess renal function (including differential renal function) and severity of ureteral obstruction based on MRU. Still, the place of this method in the diagnostic algorithm of ureteropelvicalyceal dilatation with megaureter remains underestimated. Analysis of imaging findings in a group of children diagnosed with megaureter was done.
MATERIAL AND METHODS
A retrospective analysis of magnetic resonance urography (MRU) was performed in 142 consecutive patients examined from January 2013 to September 2019. Twenty-five patients meeting the criteria of megaureter (dilatation more than 7 mm) in MRU were included in the further analysis. The MRU, ultrasound (US), and scintigraphy results were compared and analyzed together and compared with clinical data.
RESULTS
The sensitivity and specificity of US was comparable to the MRU in the assessment of upper urinary tract morphology ( > 0.05). In five out of 25 children, megaureter was found in each kidney; in a single case, both poles of a duplex kidney were affected. In the diagnosis of ureter ectopia, the MRU was superior to the US for which sensitivity did not exceed 16%. The US showed limited value in the diagnostics of segmental ureter dysplasia as a cause of primary megaureter when compared with MRU. Four cases were visualized in MRU studies, whereas the US examination was negative (all confirmed during surgery). There was a moderate correlation between relative renal function between fMRU and scintigraphy ( = 0.721, = 0.477) and in the severity of obstruction assessment between both methods ( = 0.441, < 0.05). However, in 10 kidneys with megaureter, the results in scintigraphy were inconclusive due to the signal from the megaureter imposing on the renal field.
CONCLUSIONS
MRU seems to be a preferred method in the diagnostic algorithm for megaureter, providing both anatomical and functional information. MRU is superior to US and scintigraphy in diagnosing urinary tract anomalies with megaureter.
PubMed: 35402364
DOI: 10.3389/fped.2022.839128 -
BMC Urology Mar 2020Duplex kidneys are one of the most common renal congenital abnormalities, mostly asymptomatic and of no clinical significance. There are little reports about the left... (Review)
Review
The left ureterocele and stone of calyceal diverticulum in the patient with bilateral incomplete duplex kidneys managed by flexible ureteroscopy: a case report and literature review.
BACKGROUND
Duplex kidneys are one of the most common renal congenital abnormalities, mostly asymptomatic and of no clinical significance. There are little reports about the left ureterocele and stone of calyceal diverticulum in patients with bilateral incomplete duplex kidneys managed by flexible ureteroscopy.
CASE PRESENTATION
A 69-year-old Chinese woman was presented with left waist pain for 1 month. A preoperative computed tomography (CT) scan and intravenous pyelogram revealed the left ureterocele which located in the left ureterovesical junction, and stone of calyceal diverticulum which located in the upper kidney of left incomplete duplex kidneys. The ureterocele was confirmed in view of ureteroscopy and the holmium laser was used for the resection of ureterocele. It took us a lot of efforts to find out the stone because of diverticular neck stenosis. Fortunately, when diverticular neck stenosis was incised internally by holmium laser, the stone was discovered clearly and removed using the holmium laser and nitinol stone basket through flexible ureteroscopy. A double-J ureteral stent was inserted and remained in place for 1 month. The symptom disappeared postoperatively and no complications were developed during the placement of the stent. There were no stone residents observed on CT scan before removing the ureteral stent 1 month later.
CONCLUSIONS
Flexible ureteroscopy with holmium laser is feasible to manage the ureterocele and calyceal diverticulum stones in patients with bilateral incomplete duplex kidneys in one operation.
Topics: Aged; Diverticulum; Female; Humans; Kidney; Kidney Calculi; Kidney Calices; Kidney Diseases; Laser Therapy; Lasers, Solid-State; Ureter; Ureterocele; Ureteroscopy; Urogenital Abnormalities
PubMed: 32228555
DOI: 10.1186/s12894-020-00604-7 -
Cureus Mar 2022The ureters are muscular tubes that carry urine from the kidneys to the urinary bladder and are typically implanted in the superolateral angle of the trigone of the...
The ureters are muscular tubes that carry urine from the kidneys to the urinary bladder and are typically implanted in the superolateral angle of the trigone of the urinary bladder. Although renal anomalies are common, especially in the kidneys, ectopia of the ureter is rare. Clinical presentation depends on the insertion of the ectopic ureter, varying from asymptomatic (mostly in males) to recurrent urinary tract infections (UTIs) and incontinence (mostly in females). Radiology is the best diagnostic tool to achieve a diagnosis. Ultrasound (US), intravenous renogram (IVR), micturition cystourethrogram (MCUG), and others are used to diagnose ectopic ureters, with US and MCUG being the gold standard modalities. Treatment depends on the functionality of the part drained by the ectopic ureter. Heminephroureterectomy and ureteroureterostomy are among surgical treatments for ectopic ureter, and it is either open or laparoscopic surgery. Herein, we present a case of a four-year-old female patient who presented with recurrent UTIs and incontinence.
PubMed: 35505745
DOI: 10.7759/cureus.23609 -
Journal of Surgical Case Reports Nov 2022A bifid ureter is an atypical anatomical variation that occurs with an incidence of 1-10%. This anomaly is in a continuum of duplex collecting systems and most commonly...
A bifid ureter is an atypical anatomical variation that occurs with an incidence of 1-10%. This anomaly is in a continuum of duplex collecting systems and most commonly involves a common distal ureter. This is usually asymptomatic and is predominantly an incidental diagnosis, nevertheless, is a potential risk factor for urolithiasis formation. Current surgical management of larger staghorn calculi favours percutaneous nephrolithotomy (PCNL) over traditional open surgery, however for multiple calculi and complex anatomy PCNL would require multiple punctures, with increased risk of bleeding, pleural injury, sepsis and ultimately failed stone clearance. We describe the case of a 71-year-old female with multiple calculi in bifid anatomy. A single open approach, aided with cold-ischaemia was successfully utilized in this context.
PubMed: 36452279
DOI: 10.1093/jscr/rjac547 -
The Pan African Medical Journal 2022The duplex kidney is one of the common congenital anomalies of the kidney and urinary tract. Meanwhile, renal cell carcinoma is also the most typical variant...
The duplex kidney is one of the common congenital anomalies of the kidney and urinary tract. Meanwhile, renal cell carcinoma is also the most typical variant constituting more than 90% of cancers of the kidneys. However, renal cell carcinoma is rare in a duplicated collecting system, and literature regarding its association is very sparse. Herein, we present a 28-year-old male patient who presented with abdominal pain and hematuria and was diagnosed with left upper pole renal cell carcinoma coexisted with a duplicated collecting system by computed tomography scan. The patient underwent a left partial nephrectomy followed by meticulous suturing of opened pelvicalyceal system. The histopathology result showed clear cell carcinoma. The postoperative period was uneventful, and the patient was discharged without complications. In conclusion, the coexistence of the duplex system and renal cell carcinoma in the ipsilateral kidney is rare and maybe more than a coincidence, requiring a deeper insight and further elucidation.
Topics: Adult; Carcinoma, Renal Cell; Hematuria; Humans; Kidney; Kidney Neoplasms; Male; Nephrectomy; Ureter
PubMed: 35949475
DOI: 10.11604/pamj.2022.42.42.34539 -
Frontiers in Surgery 2022To explore the treatment experience of the duplex kidney.
AIM
To explore the treatment experience of the duplex kidney.
METHOD
A case of the complete bilateral duplex kidney with severe hydronephrosis and ureterectasis in the upper moiety of the kidney diagnosed in the Department of Urology of Kunming Children's Hospital from 2021 to 2022 was retrospectively analyzed and relevant literature was reviewed.
RESULTS
A 2-month-old baby girl was admitted to the hospital because of hydronephrosis of bilateral kidneys found by prenatal ultrasound for 3 months and fever for 3 days. After being given the relevant examinations, the girl was diagnosed with complete bilateral duplex kidneys with severe hydronephrosis and ureterectasis in the upper moiety, and urinary tract infection. The patient's urinary tract infection was poorly controlled after positive anti-infective therapy, so a bilateral ureterostomy was performed. After the surgery, urinary tract infection was soon cured. A bilateral ureteroureterostomy was performed 13 months later, and the patient recovered after 7 days.
CONCLUSION
Cutaneous ureterostomy combined with late ureteroureterostomy for children with complete bilateral duplex kidneys with severe hydronephrosis in the upper moiety and ureter are not only beneficial to caregivers' nursing after the operation, but also have significance for salvaging renal function.
PubMed: 36406369
DOI: 10.3389/fsurg.2022.1019161 -
IJU Case Reports Mar 2022The reimplantation of an ectopic ureter is still performed as an open surgery, although laparoscopic or robot-assisted laparoscopic surgery has gained popularity as a...
INTRODUCTION
The reimplantation of an ectopic ureter is still performed as an open surgery, although laparoscopic or robot-assisted laparoscopic surgery has gained popularity as a minimally invasive treatment for pediatric urological disorders.
CASE PRESENTATION
A 15-day-old Japanese boy was referred to our hospital with right hydronephrosis. A detailed examination revealed complete ureteral duplication on the right side and a dilated ectopic upper pole ureter, opening into the prostatic urethra. Since the patient had recurrent febrile urinary tract infections, we performed plication and ureteral reimplantation of the dilated ectopic ureter using a transvesicoscopic surgical method at the age of 2 years and 5 months.
CONCLUSION
We safely performed transvesicoscopic ureteral reimplantation for an ectopic upper pole ureter with a mate ureter in a duplex kidney, following the detection of an ectopic ureter within the bladder, due to the prior understanding of the wrapping of both ureters in a common sheath.
PubMed: 35252800
DOI: 10.1002/iju5.12401 -
Journal of Indian Association of... Jan 2015Ipsilateral ureteroureterostomy is an established method for the treatment of duplication anomalies in children. With the advent of pediatric laparoscopy, many urologic...
AIM
Ipsilateral ureteroureterostomy is an established method for the treatment of duplication anomalies in children. With the advent of pediatric laparoscopy, many urologic procedures in children are being performed using minimal access techniques. We present our experience with laparoscopic ipsilateral ureteroureterostomy (LIUU) for duplex anomalies.
PATIENTS AND METHODS
The data of children who underwent LIUU was reviewed for demographic parameters, clinical and operative details, follow-up and results.
RESULTS
Over 3 years period, LIUU was performed in eight children (age 6-60 months). Five children had complete ipsilateral duplication with ectopic upper moiety ureter, one child each had ipsilateral incomplete duplication and bilateral duplex systems (with ipsilateral ectopic upper moiety ureter). One child had ipsilateral complete duplex with Grade V vesicoureteric reflux into the lower moiety ureter. Four children had antenatal diagnosis of hydronephrosis; three children had a urinary infection and two children presented with urinary incontinence. The surgical procedure consisted of cystoscopy, retrograde studies and cannulation of the recipient ureter. Then, LIUU was performed using three ports. The ectopic (donor) ureter was divided at the pelvic brim; the recipient ureter was opened and end-to-side LIUU was performed with 5/0 vicryl stitches over a double J (DJ) stent placed in the recipient ureter. Bladder catheter was removed after 2 days, and DJ stent was removed after 4 weeks. At a mean follow-up of 19 months (3-36), all children are asymptomatic and continent, with a significant reduction in hydroureteronephrosis on ultrasound. The cosmetic results were excellent.
CONCLUSION
LIUU is a safe and effective technique in the management of duplication anomalies in children. It could be performed with minimal blood loss, minimal postoperative pain, excellent cosmesis and good success.
PubMed: 25552828
DOI: 10.4103/0971-9261.145442 -
Cureus Nov 2022Unintentional Foley catheter placement into a ureter is an extremely rare and life-threatening complication that can be easily prevented by early diagnosis. A misplaced...
Unintentional Foley catheter placement into a ureter is an extremely rare and life-threatening complication that can be easily prevented by early diagnosis. A misplaced Foley catheter should be suspected in the presence of abdominal pain and oliguria after bladder catheterization, and congenital variation of the urinary tract can complicate this procedure. We reported the third case of misplaced insertion of a Foley catheter into the upper moiety ureter of a duplex kidney in a 19-year-old post-partum woman. The patient complained of the right flank and pelvic pain and oliguria one day after urinary catheter insertion. Duplicated right kidney, upper pole moiety mild hydronephrosis and malpositioned Foley catheter balloon in the right ectopic ureter were reported on ultrasonography which was confirmed by a CT scan. The catheter was removed easily without any complications.
PubMed: 36479397
DOI: 10.7759/cureus.31139