Surgical management of complete ureteric duplication abnormalities

Area of Science:

• Pediatric Urology
• Nephrology
• Congenital Abnormalities

Background:

• Complete ureteric duplication is a congenital anomaly affecting the urinary tract.
• It can lead to complications such as vesicoureteric reflux, ureteroceles, and ectopic ureters.
• Clinical presentations often include urinary tract infections (UTI), septicemia, and incontinence, predominantly in female patients.

Purpose of the Study:

• To review a 2-decade experience with 148 patients diagnosed with complete ureteric duplication.
• To analyze the common clinical presentations and associated abnormalities.
• To discuss the impact of prenatal diagnosis and current surgical trends focused on early detection and renal function preservation.

Main Methods:

• Retrospective review of 148 patients managed between 1974 and 1993.
• Analysis of patient demographics, clinical presentations, and specific ureteric duplication abnormalities (reflux, ureteroceles, ectopic ureters).
• Literature review focusing on early diagnosis, minimal surgery, and renal function preservation.

Main Results:

• The cohort included 72 patients with primary vesicoureteric reflux, 50 with ureteroceles, and 26 with upper-pole ectopic ureters.
• Urinary tract infection (UTI) was the most common presentation, often severe (with septicemia) or associated with incontinence.
• Prenatal ultrasonography identified 10 cases, highlighting evolving diagnostic approaches.

Conclusions:

• Complete ureteric duplication requires comprehensive management strategies.
• Emphasis is placed on early diagnosis, often facilitated by prenatal screening.
• Minimally invasive surgical techniques are crucial for maximizing renal function preservation in affected children.