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While laparoscopic heminephrectomy is performed for poorly functioning moieties, laparoscopic reconstruction with renal preservation is feasible when the affected moiety is functioning. Laparoscopic pyelopyelostomy at the level of pelvic brim can offer an alternative solution. We retrospectively reviewed the records of patients treated between 2017 and 2019 with renal duplication anomalies, and a preserved function. Five patients were identified, who underwent laparoscopic high internal diversion after placing a retrograde double J stenting in the receiving moiety. Stents were removed 8 weeks after surgery. All patients had uneventful post-operative recovery and showed clinical and radiological improvement at 1-year follow-up with no further episodes of urinary tract infection (UTI). The mean operative time was 155 min (range 130–170) and mean time to discharge was 4 days (range 2–5). The management of the duplex renal systems should be individualized for every patient. In the presence of a functioning moiety, laparoscopic reconstruction can be accomplished by pyelopyelostomy. This approach gives wider anastomosis, is easier to perform and gives better drainage than laparoscopic uretero-ureterostomy where the receiving ureter is often narrow potentially risking the normal moiety.

BACKGROUND Duplicate renal malformation is a congenital disease of the urinary system, with an incidence rate of 0.8%. Surgical treatment is suitable for symptomatic patients. Urinary fistula is one of the complications of heminephrectomy. Long-term urinary fistula has a great impact on patients' lives. CASE SUMMARY This article mainly reports on a 47-year-old man with duplication of kidney deformity, long urinary fistula after partial nephrectomy, and no improvement after conservative treatment. We have achieved positive results in the arterial embolization treatment of the residual renal artery, indicating that selective arterial embolization is a good way to treat urinary fistula after partial nephrectomy. It is worth noting that this patient violated the Weigert-Meyer law, which also gave us more consideration. CONCLUSION Renal artery embolization may be a simple and safe method to treat urinary fistula inefficacy with conservative treatment.

INTRODUCTION AND OBJECTIVE:Renal duplication anomalies may present with a ureteropelvic junction obstruction (UPJO) affecting the lower moiety. A proximal partial ureteral duplication (Y-type urete...

Heminephrectomy is the most common operation performed for renal duplication anomalies. The robot allows this complex operation to be performed through tiny incisions while allowing for three dimensional vision, greater degrees of freedom as compared to conventional laparoscopy and superior ergonomics. The surgery can be performed either transperitoneally or retroperitoneoscopically. Attention must be paid to the anatomy of the anomaly while performing the procedure. Often times, the duplex ureters run in a common sheath, sharing much of their blood supply. Overzealous dissection may lead to devascularisation of the healthy ureter, with severe complications.

Meyer-Weigert-Rule predicts the draining pattern of duplex ureters in bipolar renal duplications. The upper pole is normally seen as ectopic and therefore dysplastic due to obstruction, whereas the lower pole is related to vesicoureteral reflux. In our case, this rule is violated with uncrossed ureter duplex and a dysplastic lower pole in connection with obstruction. Keywords: Meyer-weigert-rule, Ureter duplex, Renal duplication, Megaureter

Purpose: To determine the value of fetal magnetic resonance imaging (MRI) to detect renal duplication.Methods: In this retrospective study, prenatal MRI and ultrasound (US) diagnoses were compared ...

Objectives: To report on long-term follow-up and outcomes of infants and small children who have undergone laparoendoscopic single-site (LESS) partial nephrectomy to manage upper urinary tract dupl...

A healthy 8-year-old girl presented to our hospital with fever and vomiting for 5 days. She had no complaint of flank pain during this time. On examination, she appeared exhausted, and the capillary refilling time was prolonged. Laboratory data revealed elevated inflammatory markers (white blood

Renal duplication or supernumerary kidney (SK) is a rare anomaly, poorly documented. It is often discovered fortuitously or after complications. Its preoperative diagnosis is difficult. We hereby report the case of a left supernumerary kidney discovered upon thoracic-abdominal pelvic CT staging in a 50-year-old woman monitored for squamous cell carcinoma of the cervix.

Background/Purpose: For more than a decade, endoscopic puncture of ureterocele has been recommended as an initial and, in the majority of the patients, as a definitive procedure. This study evaluates the long-term effectiveness of primary endoscopic puncture of ureterocele. Methods: Over the last 18 years (1984 through 2001), 52 patients (median age 3 months) underwent primary endoscopic puncture of ureterocele. The median follow-up was 9 years (6 months to 18 years). Antenatal ultrasound scan detected hydronephrosis and led to the postnatal diagnosis of ureterocele in 12 (23%) children, whereas in the remaining 40 (77%) children the diagnosis was made on investigation for urinary tract infection (UTI). The ureterocele presented as a part of renal duplication in 48 (92%) patients and a single system in 4 (8%). Forty-four (92%) of the patients with duplication presented with non- or poorly functioning upper poles. Vesicoureteric reflux (VUR) was seen in the lower moiety of the ipsilateral kidney in 31 and in 18 of the contralateral kidney comprising 49 renal refluxing units (RRU). Results: Complete decompression of the ureterocele was achieved in 48 (92%) patients after the first endoscopic puncture. Four (8%) patients required a second puncture of ureterocele. Nine (17%) of the 52 patients underwent nephrectomy for a nonfunctioning kidney. Ten (19%) patients required upper pole partial nephrectomy owing to nonfunctioning upper pole. Twenty-nine (59%) of the 49 RRU showed spontaneous resolution of VUR. Sixteen (33%) RRU underwent endoscopic correction of VUR. One required ureteric reimplantation. The remaining 4 (8%) are maintained on prophylactic antibiotics. Five (10%) patients had VUR in the upper pole moieties after ureterocele puncture. Conclusions: Our data suggest that primary endoscopic puncture of ureteroceles is a simple, long-term, effective, and safe procedure avoiding complete reconstruction in the majority of the patients. J Pediatr Surg 38:116-119. Copyright 2003, Elsevier Science (USA). All rights reserved .

Renal duplication anomalies are common in the pediatric population, but are frequently clinically silent. They will come to the attention of a medical provider if they develop symptoms of infection or obstruction.

Complete renal duplication is a condition in which there are two discrete renal moieties each with its own renal pelvis and ureter. The incidence of ureteral duplication in unselected autopsy series is 0.8 %. Most duplication anomalies are uncomplicated, do not result in clinical problems, and do not merit urological consultation. However, if the duplication anomaly is associated with an upper pole moiety ectopic ureter or ureterocele or lower pole moiety vesicoureteral reflux or ureteropelvic junction obstruction, urological consultation is recommended. Clinically relevant duplication anomalies are seen twice as commonly in females, with no side predilection. There is a genetic predisposition to renal duplication anomalies, as 1/8 of parents or siblings of an affected child are similarly afflicted.

A duplication artefact is sometimes encountered on ultrasound examination of the left kidney. It is caused by sound beam refraction between the spleen and adjacent fat. The purpose of this study was to analyse the frequency and types of such artefacts, and examine their physical background. The examiner searched for a left renal duplication artefact in 150 unselected abdominal ultrasound studies. A disturbed contour of the left kidney could be formed in 34 of 123 patients in whom the spleen was in the image without covering the kidney completely. An artefact was seen significantly more often when the lower pole of the spleen was rounded (30/87) than when it was wedge shaped (4/36) (p0.02). The artefacts could be categorized into complete upper pole duplication (n = 4), incomplete upper pole duplication (n = 14) and bayonet artefact (n = 16). The thickness of the renal cortex appeared reduced with upper pole duplication artefacts owing to a geometric image compression, which could also be seen in an in vitro experiment. Left renal duplication artefacts are not rare when the upper part of the kidney is examined by ultrasound through the spleen.

Renal duplication is the most common malformation of the urinary tract and is frequently seen among children with urinary tract infection (UTI).To evaluate problems in the interpretation of dimercaptosuccinic acid (DMSA) scintigraphy and to establish the range of relative function in uncomplicated unilateral duplication.Retrospective analysis of 303 children less than 2 years of age with first time non-obstructive urinary tract infection investigated by both urography and DMSA scintigraphy. At DMSA scintigraphy, renal lesions and/or relative function below 45% was considered abnormal. Urography was used as reference for the diagnosis of duplication.Duplex kidneys were found in 22 of 303 patients (7%). Of the 16 children with unilateral duplication, 10 had bilaterally undamaged kidneys with a range of relative function varying between 51% and 57% in the duplex kidney. In two of the children with unilateral duplication the imaging results were discordant.There was risk of underdiagnosis as well as overdiagnosis of renal damage at scintigraphy. Although it is important to be aware of this risk, the rate of misinterpretation was low. A range of 51% to 57% can be used as the limit for normality of the relative function of a unilateral duplex kidney.

The Weigert–Meyer rule predicts the draining pattern of duplex ureters in bipolar renal duplications. This paper introduces two cases of nonpolar renal duplication. A 3-month-old and a 15-year-old female with history of urinary tract infection were evaluated with intravenous pyelograms (IVP) and eleven different parameters were analyzed. The infant’s IVP showed an unobstructed side-to-side right renal duplication with normal-sized nondisplaced lateral moiety and a complete set of calyces, without drooping lily sign. The nonobstructed moiety projected medial and mildly inferior to the lateral moiety which had normal height and axis. The ureters joined each other in lower abdomen. Severe platyspondyly was noted due to hyperalimentation-induced metabolic bone disease. The second case had an unobstructed interpolar extra moiety between the upper and the lower poles with an otherwise unobstructed, normally sized single-system kidney, without drooping lily sign. The paradigm shift from classic anatomic to contemporary cell biological theory validates the nonpolar renal duplication concept, with side-to-side and interpolar arrangements of the moieties, in defiance of Weigert–Meyer rule.

Duplication of the ureter and renal pelvis is the most common upper urinary tract anomaly in childhood with a reported incidence of 0.8%. Familial nature of vesicoureteral reflux (VUR) is well recognized with a prevalence of 27-51% in siblings of children with VUR and 66% rate of VUR in offsprings of parents with previously diagnosed VUR. Although VUR is known to be the most common abnormality associated with renal duplex systems, the prevalence and significance of renal duplication in familial VUR is not known. The aim of this study was to determine the prevalence and significance of duplex collecting systems in familial VUR.Between 1998 and 2009, the parents of 237 index patients with grade III-V VUR were asked permission to screen siblings younger than 6 years old for VUR. A total of 513 children in 237 families were identified to have VUR (237 index patients, 276 siblings). Families were divided into three groups: Group I, families with only boys affected Group II, families with only girls affected and Group III, families with boys and girls affected.In 39 families (16.5%) only boys had VUR (Group I), in 89 families (37.5%) only girls had VUR (Group II) and in 109 families (46%) boys and girls were affected (Group III). Duplex collecting systems were present in 39 (7.6%) patients. The prevalence of duplex systems was significantly higher in Group I (15%) compared to Group II (6%) and Group III (6.4%), (p0.01). Duplex systems were present in 15% of boys in Group I and only in 4% of boys in Group III (p0.01). Patients with duplex systems had a significantly higher grade of VUR than patients without duplex systems (p0.01).Families with exclusively boys affected with VUR have a higher rate of prevalence of duplex collecting systems. This has implications for genetic counseling and for modeling the inheritance of VUR.

In complete renal duplication, upper moiety is obstructed and lower moiety refluxing in most instances. Nonfunctioning moieties, especially the obstructed systems need heminephrectomy. A separate vessel supplying nonfunctioning moiety makes heminephrectomy technically easier.

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Introdução: A duplicidade renal é uma anomalia congénita com possível suspeição pré-natal que, por se associar frequentemente a outras anomalias nefro-urológicas, importa diagnosticar precocemente. Objectivo: Avaliar o processo de diagnóstico e a evolução dos casos de duplicidade renal. Material e Métodos: Estudo retrospectivo de crianças com duplicidade renal nascidas entre 1996 e 2003. Resultados: Identificaram-se 17 casos de duplicidade renal, que em 15 se associaram a outras anomalias, mormente o refluxo vésico-ureteral. Treze crianças necessitaram de tratamento cirúrgico. Com tempo médio de seguimento de 4 anos ± 11 meses, verificou-se perda importante da função renal unilateral em 4 casos, não se registando em nenhum insuficiência renal global. Conclusão: Numa larga maioria de casos identificou-se a associação entre duplicidade renal e outras anomalias morfo-funcionais renais, destacando-se o refluxo vésico-ureteral. Todas as crianças mantiveram função renal global adequada, admitindo-se que para tal tenha contribuído a precocidade do diagnóstico e seguimento atempados. ABSTRACT Introduction: Duplex system is a congenital anomaly possibly detected in utero, often associated to other comorbidity urinary tract anomalies which should be early recognized. Aims: To assess the diagnosis and postnatal course of cases of duplicated collecting system. Material and Methods: Retrospective study of cases of duplex system in children born between 1996 and 2003. Results: In 15 of the 17 cases with duplex system other abnormalities were identified, mainly vesicoureteral reflux. In 13 children any kind of surgical repair was performed. After a mean follow-up period of 4 years ± 11 months, signifi cant loss of unilateral renal function occurred in 4 patients, but none had global renal impairment. Conclusions: In most patients an association between duplicated collecting system and other urological abnormalities was detected, vesicoureteral refl ux the most frequent. In the follow-up period all children presented an adequate renal function. We emphasise that an early diagnosis and management can surely contribute to better results in cases of duplicated collecting system.

Ureteral valves are a rare clinical finding. Frequently they are associated with other urological anomalies such as complete or incomplete renal duplication, ectopic ureter, vesicoureteral reflux and horseshoe kidney. Hydronephrosis is the most common clinical sign. We report two cases of ureteral valves recently encountered at the Surgical Department of Sant Joan de Deu Hospital in Barcelona, and discuss the diagnosis and surgical treatment with a review of the literature from 1926.

Renal duplications and fusion anomalies in children often present challenging problems. The diagnostic evolution of these entities often consists of upper tract imaging to evaluate function and help diagnose obstruction, and lower tract imaging to assess reflux and at times voiding dynamics. The clinician needs to be aware of the variable presentations of these lesions, their evolution, and the therapeutic interventions that may be required to resolve problems resulting from them.

We reviewed our experience with contralateral vesicoureteral reflux following unilateral ureteroneocystostomy.We retrospectively identified 88 children who underwent unilateral ureteroneocystostomy from 1986 through 1995, including standard repair in 69 and tapered repair in 19. Cystoscopy was performed in all cases immediately before repair.Grades IV to V vesicoureteral reflux was identified preoperatively in 34% of the patients, including 13 (19%) and 14 (74%) who underwent standard and tapered repair, respectively. Renal duplication was noted in 24% of the cases, including 18 standard (26%) and 3 tapered (16%) repairs. An abnormal contralateral nonrefluxing ureteral orifice was present in 8 of the 53 standard (15%) and 3 of the 14 (21%) tapered cases. Ipsilateral reflux was corrected in all children undergoing standard repair but it persisted in 4 (21%) in the tapered repair group. Postoperatively contralateral vesicoureteral reflux developed in 1 child (1.4%) in the standard and 1 (5.3%) in the tapered repair group.Contralateral vesicoureteral reflux is rare and does not appear to be influenced by preoperative reflux grade, a duplicated system or the endoscopic appearance of the ureteral orifice.

An extremely rare incomplete duplex system with cystic dilatation of the upper part of the conjoint ureter presenting as hydronephrosis in a 2-year-old infant is reported.

Purpose To evaluate the long term outcome after the one-stage laparoscopic hemi-nephroureterectomy with simultaneous excision of ureterocele, and reimplantation of the normal moiety ureter. Material and methods Nineteen patients (M/F: 3/16) underwent the procedure. Mean age at surgery was 1.81years (range 1m - 7.24 years). All patients had a duplex system with a non- functioning upper moiety and large complicating ectopic caecoureterocoeles which persisted despite previous cystoscopic incision. VUR occurred in 8 patients (3 bilateral). All patients underwent the one - stage laparoscopic procedure via a transperitonial route with endoscopic upper pole heminephrectomy with extravesical excision of the ureterocele, and reimplantation of the lower moiety ureter. All patients were regularly followed every 3 months and repeated radiological assessments including US, VCUG and DMSA were done at 12 months and then at yearly interval afterwards. Complete resolution of the VUR was confirmed based on negative findings on follow up VCUG. Results The procedure was successful in all patients and no procedure-related complications were observed. Mean follow up was 4.45 years (range.1.1 – 8 yrs). None of the patients in this series showed functional loss in the remaining ipsilateral moiety. Follow-up cystogram showed complete resolution of VUR in all 8 patients (100 %). Two patients developed UTI during the follow up period and none of them developed a new renal scar. Cosmetic results were excellent in all patients and no long-term complications have been encountered so far. Conclusions Our experience demonstrates that this radical definitive surgery can be safely and effectively performed in a single stage laparoscopic procedure. The procedure minimizes the hazards of traditional open surgical reconstruction. Furthermore, the long-term successful outcome in our series establishes this unique procedure as safe and effective in treating infants with renal duplication associated with ectopic ureteroceles.

The child with ectopic ureterocele frequently presents a diagnostic challenge. The use of standard excretory urography combined with newer modalities, such as ultrasonography and radionuclide renal scanning, provides an orderly diagnostic approach to ectopic ureterocele. This integrated approach should ensure the highest yield in a diagnostic sense and aid in assessing upper tract function, thus, helping with the selection of the proper surgical management.

We have seen 5 children with a non-obstructive ectopic ureterocele associated with an undilated upper pole collecting system. Thus the telltale signs of renal duplication found with obstruction of the upper pole were absent. Cystoscopy confirmed the diagnosis when retrograde injection of the ureterocele outlined a narrow ureter and small dysplastic kidney. Because reflux usually was present in the ipsilateral lower pole ureter (86 per cent) surgical treatment consisted of excision of the ureterocele and common sheath ureteral reimplantation. Removal of the small non-functioning upper renal segment was not necessary in most instances. The embryology of this anomaly is discussed.

The diagnoses of complete obstruction in a duplicated renal collecting system and ureterocele can be made with a high degree of confidence by ultrasound. Two children presenting with abdominal masses were examined by gray scale ultrasonography which demonstrated large cystic masses dorsal to and displacing the lower pole of the kidney ventrally and laterally. In one patient the dilated ureter terminated in a ureterocele. Ultrasonography is the appropriate imaging modality for this disease process, though it generally becomes the complementary study to excretory urography in the diagnosis of an obstructed duplicated system. The dilated pelvis and ureter can be imaged to ultrasonography even when their presence is only implied on an excretory urogram. Finally, the cystic nature of a ureterocele, as well as its relationship to the ureter and bladder, makes ultrasonography an ideal technic for evaluating this anomaly.

Absolute kidney length and the ratio of right to left kidney lengths were estimated by the method of Eklof & Ringertz in a series of 142 patients with unilateral renal duplication. The anomalous kidney was frequently found to be larger than the contralateral one, particularly when associated with ectopic ureterocele, which was present in 34 patients. Nevertheless, a substantial number of reduplicated kidneys had a length below mean, some of them actually below -2SD.

To determine the appearance of artifactual renal duplication in ultrasound (US) imaging, the authors analyzed 22 examples of such duplication in 20 patients. The artifact appeared as a duplication of the collecting system in 18, as a suprarenal mass in three, and as upper-pole cortical thickening in one. It occurred in the left kidney in 15 patients, in the right kidney in three, and bilaterally in two. To determine the frequency of the artifact, 50 additional patients were scanned. It was identified in eight of these patients. Imaging characteristics and the results of in vitro modeling proved the artifact was due to sound beam refraction between the lower pole of the spleen or liver and adjacent fat. This artifact is much more common in the left kidney and occurs more frequently in obese patients. Knowledge of the appearance and cause of this artifact should help radiologists avoid diagnostic errors.