Single-Setting Laparoscopic Treatment of Complete Bilateral Ureteral Duplication in Adult Women

Abstract

Complete bilateral ureteral duplication has a low incidence in adult age. It is an uncommon etiology of urinary incontinence (UI) in adult women. The aim of this study is to report a series of 12 laparoscopic upper-pole partial nephrectomies, to highlight the feasibility of a single-setting treatment for this rare condition. To report our experience with single-setting bilateral laparoscopic upper-pole partial nephrectomy (SSBLUPPN) for the treatment of UI in adult women affected by a complete bilateral ureteral duplication and hypofunctional upper-pole renal moieties. Between February 2002 and November 2009, 6 female patients underwent SSBLUPPN for complete bilateral ureteral duplication with poorly functioning upper-pole renal moieties. Mean patient age was 38. Every patient complained of a continuous UI or a history of recurrent urinary tract infections (UTIs). All the patients underwent a preoperative evaluation with an abdominal ultrasonography, magnetic resonance imaging of the urinary tract, and a renal scan with DTC99. The analysis endpoint was the technical feasibility of SSBLUPPN as assessed by the operative time, estimated blood loss, postoperative course, and 3-year functional outcomes. All the procedures were successfully performed with no conversion to open surgery with a mean operative time of 244 minutes. Mean estimated blood loss was 236 cc. No major intraoperative complications occurred in all the cases. All the patients showed no clinical signs of UTIs postoperatively. At a mean follow-up of 36 months, we found no hydronephrosis and complete remission of UI and UTIs in 100% of cases. SSBLUPPN is feasible and associated with minimal morbidity, an excellent cosmetic result, and a short hospital stay. A single-setting treatment of complete ureteral duplication is a technically demanding procedure, and it should be performed only in centers with large experience in laparoscopic renal surgery.