Ureteral duplication anomalies: two years' experience in a single center
Ahmed Oshiba1, Samar Oshiba2, Mostafa Kotb3
1Department of Pediatric Surgery, Faculty of Medicine, Alexandria University, Alexandria, 21615, Egypt.
Background:
Ureteral duplication is one of the most common anomalies affecting the genitourinary system. A broad spectrum of clinical presentations and involvement leads to challenges in diagnosing and treating pediatric urologists. Among the variations commonly encountered are incomplete and complete ureteral duplications with normally developed renal moieties and ureters. In this study, we report our experience regarding this spectrum of anomalies in terms of clinical presentation, workup, and management.
Methods:
This study was conducted as a single-center retrospective study at our institution from January 2019 to January 2021 on children diagnosed with ureteral duplication anomalies. preliminary renal ultrasonography (RUS) and baseline serum urea and creatinine were done for all patients. This was followed by voiding cystourethrography (VCUG) and magnetic resonance urography (MRU) for anatomical definition as needed and dimercaptosuccinate (DMSA) renal scintigraphy for functional decision.
Results:
This study included 28 children diagnosed with renal duplex anomalies. Of our 28 patients, 4 had ectopic obstructing megaureter with dilated upper moiety segment (3 left-sided, 1 right-sided), 6 had lower moiety refluxing ureter (4 left-sided, 2 right-sided), and 3 had refluxing ureter in upper and lower moieties (para-ureteral diverticulum). Lower moiety pelviureteric junction obstruction was diagnosed in only 1 case. 13 cases were diagnosed with ureterocele obstructing the upper moiety segment (9 left-sided, 4 right-sided), of which 2 presented early with dysplastic upper moiety in 1 and dysplastic whole kidney in the other, and 4 were cecoureterocele and prolapsing through bladder neck obstructing the bladder outlet. One duplex system was found to drain in the bladder with a single ureteric opening, indeed a rare anatomical variant (incomplete duplex).
Conclusion:
Ureteral duplications, ectopia, and ureteroceles are uncommon, widely variable, and challenging clinical entities. Since there is no standard management protocol, a conservative approach is worth consideration. A thorough, detailed imaging study is key to delineate anatomical variations. Our chosen bottom-to-top approach proved successful in recruiting functional upper-moiety nephrons. Ureteroureterostomy and laparoscopic upper moiety heminephroureterectomy are both safe and feasible procedures in properly selected cases.
Clinical Trial Number:
Not applicable.
