[Diagnosis and therapy of ectopic ureters and ectopic ureteroceles with double kidneys]

Diagnosis and treatment of ectopic ureters and ectopic ureteroceles with renal duplication is a rewarding challenge for any urologist, requiring specific knowledge, awareness of the anomaly and good surgical technique. The diagnosis is primarily based on the correct interpretion of the medical history and the excretory urogram, irreplaceable by sonography. Confusing details can easily be interpreted when the anomaly is detected, or the patient will be left on a long and frustrating path of medical treatment, diagnostic interventions, possibly leading to psychotherapy. The classical triad: renal duplication, incontinence and normal micturition is rarely helpful in complicated cases, compared to the typical findings on the excretory urogram which sometimes are incomplete or only suggestive but still have the highest diagnostic value. Their recognition usually leads to correct diagnosis and treatment. Modern surgical and anesthesiological techniques allow a one stage approach to correct the anomaly and avoid further complications. However, if the risk is considered to be too high, a two stage approach is justified starting with a heminephrectomy. After this 20% will require further surgical treatment of the bladder, due to complications. Dysplastic and nonvisualizing renal segments should not be preserved nor should dilated, ectopically ending ureters. Minimal surgical interventions, reducing, but not solving the problem (incision of ureteroceles, interpelvic anastomosis) are not recommended in modern urological treatment.