Complete Duplication Research Articles

Bilateral complete duplication of ureter with ectopic ureter presenting as persistent urinary dribbling with normal voiding pattern in 17-year-old female: Case report

and importance: Bilateral complete ureteral duplication is a rare urinary tract abnormality and presence of unilateral ectopic ureter makes it a rarest entity. Continuous urinary dribbling with normal voiding pattern and recurrent UTI are frequent presenting complains in case of ectopic ureter. Long term childhood problem of urinary incontinence with delayed diagnosis in adult in this case makes it a perfect case to report. We present a case of 17-year-old girl with continuous urinary dribbling and constant wetting with normal voiding pattern since childhood. She also had recurrent history of urinary tract infections. Local external examination of genitourinary system was found to be normal. There were skin lesions on buttocks and thighs suggestive of urine dermatitis. There were no examination findings of other congenital anomalies. Complete blood count, Renal function test, Serology, Urine R/ME, Urine culture and sensitivity, Ultrasound abdomen and pelvis, Computed Tomography scan, intraoperative cystoscopy were done. Right upper pole hemi nephroureterectomy was performed. She was post operatively managed with IV Fluids, antibiotics, analgesics, antipyretics and antiemetics. She is asymptomatic now and regularly followed up on OPD basis. Congenital abnormalities of the genitourinary system like ectopic ureter should be clinically suspected in case of persistent urinary problems like urinary dribbling with normal voiding pattern and recurrent urinary tract infections. Upper pole heminephrectomy is an ideal choice of treatment in case of nonfunctional upper moiety. This case emphasizes the early detection of genitourinary abnormalities and provide the perspective on late diagnosis and management in such cases.

Analysis of Single Event Transient Effects in Standard Delay Cells Based on Decoupling Capacitors

Single Event Transients (SETs), i.e., voltage glitches induced in combinational logic as a result of the passage of energetic particles, represent an increasingly critical reliability threat for modern complementary metal oxide semiconductor (CMOS) integrated circuits (ICs) employed in space missions. In rad-hard ICs implemented with standard digital cells, special design techniques should be applied to reduce the Soft Error Rate (SER) due to SETs. To this end, it is essential to consider the SET robustness of individual standard cells. Among the wide range of logic cells available in standard cell libraries, the standard delay cells (SDCs) implemented with the skew-sized inverters are exceptionally vulnerable to SETs. Namely, the SET pulses induced in these cells may be hundreds of picoseconds longer than those in other standard cells. In this work, an alternative design of a SDC based on two inverters and two decoupling capacitors is introduced. Electrical simulations have shown that the propagation delay and SET robustness of the proposed delay cell are strongly influenced by the transistor sizes and supply voltage, while the impact of temperature is moderate. The proposed design is more tolerant to SETs than the SDCs with skew-sized inverters, and occupies less area compared to the hardening configurations based on partial and complete duplication. Due to the low transistor count (only six transistors), the proposed delay cell could also be used as a SET filter.

Bilateral complete duplication of ureters with upper moiety PUJO and ectopic insertion: A rare case report

Duplication of the ureter and renal pelvis is one of the most common anomalies of the upper tracts with incidence reported to be approximately 2% [1]. An increased incidence of uretero-renal pathology has been documented with duplication anomalies. Here we present a case report of a 27-year-old married male who presented with a bilateral complete duplex system with ectopic insertion into the prostatic urethra. On evaluation he was found to have a non-functioning left upper moiety and a right upper moiety ureteropelvic junction obstruction. In this case report we discuss the complications and therapeutic implications of a duplicated system.

Trisomy-6: The Ying and Yang of Chromosome 6 Aberrations

Karyotypic aberrations of chromosome 6 (chr.6), include duplications (trisomy 6; +6), deletion of its short arm (del6p), uniparental disomy 6 (UPD6p), as well as various microduplications and microdeletions. Among many important genes, the HLA locus is located on 6p, and loss of heterozygosity and allelic loss have been described as means of immune escape in immune-mediated aplastic anemia (AA) and in relapse of myeloid neoplasia following allogeneic bone marrow transplant. The pathogenesis of duplication of chr.6 appears more complex and might involve deletion of a putative tumor suppressor gene (TSG) causing duplication of the HLA locus with increased HLA expression. We have encountered several patients with +6 who inspired us to investigate the clinical and molecular phenotypes of +6. A total of 29 +6 MDS patients were identified, of whom 16 had isolated +6 (Iso +6). When compared to normal karyotype (NK) MDS (n=420), median age was younger in Iso +6 (70 vs 42 years, P<.0001). While no differences were noted for white blood counts, Iso +6 patients had lower platelets (median 27 vs. 112 x 103/uL, P=.19), were more frequently anemic (median hemoglobin 8.4 vs. 9.5 g/dL, P=.04) and showed higher frequency of hypocellularity at marrow evaluation (62.5% vs. 9.5%, P=0.0016) as opposed to NK MDS. Indeed, 67% of Iso +6 patients had a clinical picture reminiscent of AA or MDS phenotype which might have evolved from an antecedent AA phase. However, 67% of Iso +6 MDS had high risk MDS (IPSS-R ≥3.5) and 37% transformed to AML. Thus, our cohort indicated a phenotypic dichotomy which include hypocellular MDS/AA and high-risk disease with a poor prognosis. Of all +6 MDS, mutations most commonly affected TP53 (69%) followed by EZH2 (19%). Recurrent copy number variations (CNV) such as micro-duplications and microdeletions may be used to identify culprit genes. Indeed, microdeletions involving HLA have previously hinted towards the pathogenic role of HLA deletions. We obtained CNV data and compared them to conventional germline chromosome 6 CNV gains publicly available in the Database of Genomic Variants (DGV). Genes pertaining to significantly duplicated segments were then identified using the UCSC Genome Browser (https://genome.ucsc.edu/cgi-bin/hgGateway). In our cohort, in addition to 833 cases with del6p, we have identified microduplications involving 6p locus in 115 (11.5%) NK MDS cases. Overall, a total of 1198 6p copy gains were found in these patients, ranging in size 0.09-7.8Mb and with a median of 0.12Mb. The genomic architecture of each segment was investigated using the UCSC Genome Browser, from which only complete gene duplications that mirror an extra chromosomal copy were considered. Complete duplications were most commonly seen in loci containing genes of DUSP22 (12.2%) and most importantly HLA-DRB1 (10.4%), HLA-DRB5 (10.4%), HLA-DQA1 (9.6%) and MICA (9.6%). All of these five genes were significantly enriched in NK MDS as compared to healthy controls (DUSP22 3% P<0.0001, HLA-DRB1 0.4% P<0.0001, HLA-DRB5 0.5% P<0.0001, HLA-DQA1 0.5% P<0.0001 and MICA 0.2% P<0.0001) (Fig 1). Interestingly, while checking the Cosmic Cancer Browser database (https://cancer.sanger.ac.uk), we noticed that copy gains involving HLA-DRB1 and HLA-DRB5 were also more common in primary AML than in healthy controls from DGV (3.6 vs 0.4%, P<0.0001 and 3.6 vs 0.5%, P<0.0001, respectively). While the involvement of the HLA genes hints towards an immune-mediated mechanism underlying the pathogenesis of +6 MDS, further involvement in primary AML may suggest a common mechanism through which CN gains of the HLA locus promote myelo-neoplasia. We stipulate that while clonal deletion or UPD of HLA locus can be a result of immune pressure as seen in AA and during GvL, clonal duplication may lead to increased autoantigens presentation beyond the TCR activation threshold, triggering immune reactions ultimately resulting in hypocellular marrow and AA-like presentation. Alternatively, +6 and related lesions may lead to risk allele duplication and consequential more efficient presentation of a specific antigenic peptide. In more advanced diseases, deletion of TSG may also play a role, with progression reflecting a somatic pressure to overcome immune inhibition. HLA constellation and mutational studies will be presented in the context of the findings of 6p duplications and microdeletion in MDS and AA. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A Two-Year-Old Boy with Diphallia and Multiple Congenital Anomalies

Diphallia is a rare urogenital defect and varies from a small accessory penis or duplication of the glans to complete penile duplication. Its incidence is 1 in 5.5 million live births. Only 100 cases were reported from 1609 until 2021. A two-year-old boy with diphallia and multiple congenital anomalies had an uncircumcised penis with two glans penis and two complete urethral orifices, accompanied by scrotum bifidum, asymmetric right buttock, with normal anorectal position. Spina bifida with lipomyelocele, tethered cord at the level of vertebra lumbar 3-4, scrotum bifidum, and left mild hydronephrosis were observed using Magnetic Resonance Imaging (MRI). Urethrocystoscopy of both complete urethra revealed meatal stenosis and bulbar urethral stricture, normal posterior urethral, and no verumontanum in the right urethral orifice and did dilatation. Whereas normal urethral orifice, anterior urethra, posterior urethra and verumontanum were found in the left side. Management for diphallia must consider associated anomalies and the goal of patient satisfaction. In this case, conservative treatment is the best choice.

Pediatric robot-assisted extravesical ureteral reimplantation (revur) in simple and complex ureter anatomy: Report of a multicenter experience

Robot-assisted extravesical ureteral reimplantation (REVUR) is a well established approach for surgical treatment of pediatric vesicoureteral reflux (VUR). However, further evidence is needed to confirm its efficacy even in case of complex anatomy. This study aimed to further confirm the evidence that REVUR is safe and effective in both simple and complex ureter anatomy. The charts of all patients with VUR, who received REVUR in 6 different institutions over a 5-year period, were retrospectively reviewed. Patients with both simple and complex ureter anatomy were included. Patient demographics, surgical variables, and post-operative results were assessed. VUR resolution was defined as either being resolved VUR on voiding cystourethrogram (VCUG) or clinically without symptoms during the follow-up. Fifty-seven patients with median age of 6.9 years (range 4.5-12), receiving REVUR in the study period, were included. Eighteen (31.6%) patients had complex anatomy and included prior failed endoscopic injection (n=13), complete ureteral duplication (n=2), periureteral diverticulum (n=2), ectopic megaureter requiring dismembering (n=1). The median operative time was 155min for unilateral and 211.5min for bilateral repairs. The clinical+radiographic VUR resolution rate was 96.5%. Post-operative complications (Clavien 2) included urinary retention following bilateral repair (n=5, 8.7%), febrile urinary tract infection (UTI) (n=6, 10.5%) and gross hematuria (n=3, 5.2%). Comparative analysis between simple and complex cases showed that REVUR was faster in simple cases in both unilateral [p=0.002] and bilateral repair [p=0.001] and post-operative urinary retention was more frequent in simple cases [p=0.004] and in patients with pre-operative bowel and bladder dysfunction (BBD) [p=0.001] (Table). This series confirmed that the robot-assisted technique was feasible even in cases with complex anatomy using some technical refinements, that justified the longer operative times in both unilateral and bilateral cases. An interesting finding of this study was the correlation emerged between BBD and risk of post-operative urinary retention and VUR persistence. Our results also excluded any significant correlation between complex cases and risk of post-operative urinary retention. The main study limitations included the retrospective and nonrandomized design, the small number of cases and the arbitrary definition of complex anatomy. REVUR was safe and effective for management of VUR in both simple and complex ureter anatomy. Complex REVUR required slightly longer operative times, without significant differences in post-operative mordidity and success rates. Aside from complex anatomy, BBD emerged as the main risk factor associated with surgical failure and post-operative morbidity.

A Rare Case of Complete Urethral Duplication and Short Review of the Literature

Abstract Duplication of the urethra is a rare congenital anomaly, predominantly seen in males. Due to the rarity of the condition, there is no fixed consensus regarding the management of these patients. We report the case of a 4-year-old male child who presented with phimosis and balanoposthitis, with the occasional double stream of urine and was incidentally found to have duplication of the urethra. Cystoscopy revealed the duplication to be Effman Type II A-1. No surgical intervention was done for the duplication as the patient was asymptomatic. Our aim is to report this rare case and to enhance the knowledge by reviewing the already existing scanty literature of this rare condition.

Lower pole obstructive megaureter of duplex kidney: an exception to the Weigert-Meyer rule

Introduction. Anatomical features of the urinary tract in patients with duplicate kidneys are described using the Weigert-Meyer rule, since the orifice of the upper ureter has an ectopic location (inferomedial) and the orifice of the lower ureter has an orthotopic location (superolateral). However, there are rare cases of violation of this rule, complicated by obstructive megaureter, ectopic ureteral orifice, the presence of ureterocele.Objective. To report the rare clinical case of a lower pole obstructive megaureter as a violation of the Meyer-Weigert rule in the patient with complete ureteral duplication and to describe the use of ureteroureterostomy as an effective and safe method of surgical correction of the presented anomaly.Clinical case. We present a case of the infant (5 months old) with a lower pole obstructive megaureter. This pathology was identified through intravenous urography and voiding cystourethrography. Laparoscopic proximal end-to-side ureteroureteroanastomosis was chosen as a surgical treatment. Postoperative control intravenous urography showed the effectiveness (a reduction in the lower pole collecting system of the duplex kidney was revealed) and the safety of this method of correction.Conclusion. There are only several clinical cases about exceptions to the Weigert-Meyer rule reported in literature, and most of them are about adult patients. The main surgical method of treatment in such cases is heminephrectomy. To our knowledge, this is the only reported case of using ureteroureterostomy in the patient with a lower pole obstructive megaureter. This technique has shown its effectiveness and safety for restoring the patency of the urinary tract, confirmed during the control postoperative examination.

Laparoscopic treatment of bilateral duplex kidney and ectopic ureter: A case report

BACKGROUNDDuplication of the renal pelvis is a common congenital malformation of the urinary system. About one-third of cases are complete unilateral duplication of the renal pelvis, while bilateral duplication is extremely rare. Herein, we described a single case of bilateral renal duplication with double ureteral orifice ectopic vaginal fistula treated with laparoscopy. CASE SUMMARYA 6-year-old girl suffering from long-term vaginal leakage was admitted on June 10, 2018. She was diagnosed with complete duplication of both kidneys and ureters and ectopic opening of both ureters combined with ureterovaginal fistula. The patient received laparoscopic ectopic ureteral bladder replantation and was followed up for 2 years. No renal function damage and vaginal leakage were found.CONCLUSIONLaparoscopic bladder-ureter reimplantation could effectively determine the location and number of ectopic ureters by imaging and cystoscopy.

Lower pole anatomy of horseshoe kidney and complete ureteral duplication: Anatomic and radiologic study applied to endourology

ABSTRACTPurpose:To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with complete ureteral duplication (CUD), in polyester resin endocasts of the collecting system and in patients submitted to 3D computerized tomography scan (CT-scan).Materials and Methods:We analyzed seven 3-dimensional polyester resin endocasts of the kidney collecting system obtained from 6 fresh adult cadavers (4 with unilateral CUD and 2 with horseshoe kidney) and CT-scan reconstruction images of kidneys from 24 patients: 6 patients with HK, 8 with CUD and 10 patients without renal anomalies that were used as controls. We analyzed the spatial distribution of the calices, the infundibula diameters, the angle between the lower infundibulum and the renal pelvis (LIP) and the angle between the lower infundibulum and the inferior minor calyces (LIICA). Measurements of the width and length of the inferior infundibulum and the infundibula of the minor calyces, as well as the angles (LIP and LIICA) were made with the aid of the LibreOffice 6.3 software. The data were analyzed with the IBM® SPSS® Statistics.Results:There was no statistical difference in the inferior pole measurements between the groups with anomalies and the control group, both in polyester resin endocasts and CT-scan reconstruction images for LIP. When we compared the LIP in the CT-scan between HK versus CUD (p= 0.003), and HK versus the control group (p= 0.035), we observed statistical difference.Conclusions:The knowledge of spatial anatomy of lower pole is of utmost importance during endourologic procedures in patients with kidney anomalies. In the present study we observed that horseshoe kidneys had more restrictive anatomic factors in lower pole than the complete ureteral duplication.

Molecular basis for the initiation of DNA primer synthesis.

During the initiation of DNA replication, oligonucleotide primers are synthesized de novo by primases and are subsequently extended by replicative polymerases to complete genome duplication. The primase-polymerase (Prim-Pol) superfamily is a diverse grouping of primases, which includes replicative primases and CRISPR-associated primase-polymerases (CAPPs) involved in adaptive immunity1-3. Although much is known about the activities of these enzymes, the precise mechanism used by primases to initiate primer synthesis has not been elucidated. Here we identify the molecular bases for the initiation of primer synthesis by CAPP and show that this mechanism is also conserved in replicative primases. The crystal structure of a primer initiation complex reveals how the incoming nucleotides are positioned within the active site, adjacent to metal cofactors and paired to the templating single-stranded DNA strand, before synthesis of the first phosphodiester bond. Furthermore, the structure of a Prim-Pol complex with double-stranded DNA shows how the enzyme subsequently extends primers in a processive polymerase mode. The structural and mechanistic studies presented here establish how Prim-Pol proteins instigate primer synthesis, revealing the requisite molecular determinants for primer synthesis within the catalytic domain. This work also establishes that the catalytic domain of Prim-Pol enzymes, including replicative primases, is sufficient to catalyse primer formation.

Successful full-length sealing and division of the common wall in a 2-year-old boy with complete tubular colorectal duplication

We report a case of complete tubular colorectal duplication that was treated with division through the full-length of the common wall using an articulating advanced bipolar sealing device. A 2-year-old boy who presented with excessive abdominal distension was found to have complete tubular colorectal duplication at laparotomy, and appendicostomy using the duplicated appendix was created temporarily to decompress the duplicated colon. Contrast colonography through the appendicostomy and abdominal MRI detected no luminal communication between the main and duplicated colon. Because the duplicated colon wall appeared equivalent to the main colon, which was confirmed histologically, surgical repair was conducted by dividing the septum between the main and duplicated colon using an articulating advanced bipolar sealing device, from the cecum to the rectum. The septum of the lower rectum was divided trans-anally with the same device. Postoperative colonoscopy confirmed the patency of a single common lumen of the entire colon and rectum. At two years after the operation, the patient was well except for mild and transitory constipation.

V08-08 MANAGEMENT OF URETHRAL DUPLICATION

You have accessJournal of UrologyCME1 May 2022V08-08 MANAGEMENT OF URETHRAL DUPLICATION Patrick Curtin, Yu Zheng, Jessica Connor, and Shumyle Alam Patrick CurtinPatrick Curtin More articles by this author , Yu ZhengYu Zheng More articles by this author , Jessica ConnorJessica Connor More articles by this author , and Shumyle AlamShumyle Alam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002606.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral duplication is a rare congenital condition in which there is a complete or partial duplication of the urethra. As of 2016 there were less than 300 reported cases of this condition reported in the literature. This video sought to demonstrate the operative technique used to correct a Type 1B urethral duplication. METHODS: After informed consent was obtained photos and video footage were collected. RESULTS: This video includes epidimiologic information on urethral duplication, a patient presentation of Type 1B urethral duplication, and the surgical technique used to correct this. CONCLUSIONS: Urethral duplication is a rare congenital malformation that can be surgically corrected. The exact type of surgical correction is dependent on the type of duplication as well as any concomitant genitourinary abnormalities. Source of Funding: No funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e716 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Curtin More articles by this author Yu Zheng More articles by this author Jessica Connor More articles by this author Shumyle Alam More articles by this author Expand All Advertisement PDF DownloadLoading ...

Voiding cysto-urethrography of complete urethral duplication in a child, a case report

BackgroundUrethral duplication is a very uncommon congenital anomaly that predominantly affects males. This condition is distinguished by the presence of two urethras, which might be incomplete or complete. The diagnosis of urethral duplication is very important, and missing this diagnosis leads to the delayed surgical correction of patients. Voiding cysto-urethrography is an important diagnostic method to diagnose the urethral duplication that can provide a standard view for surgical operation and determine the type of duplication.Case presentationIn the present study, we report a 5-year-old boy with complete urethral duplication diagnosed via voiding cysto-urethrography in our medical center. We reviewed the classification of this anomaly, indications of surgery, the importance of voiding cysto-urethrography, and the role of other imaging modalities to diagnose the urethral duplication.ConclusionFor children with a double urinary stream, a complete genital examination and radiological assessment are required not only to diagnose urethral duplication but also to determine the kind of urethral duplication and rule out related anomalies. These findings guide surgeons in planning the best treatment for the patients to prevent future complications. Voiding cysto-urethrography is one of the most useful and beneficial procedures to diagnose the urethral duplication which can be used as a first imaging modality, especially when there are double functional urethras.

Complete unilateral duplication of the right ureter with ectopic orifice into the prostatic urethra found by transrectal ultrasound.

Complete unilateral duplication of the right ureter with ectopic orifice into the prostatic urethra found by transrectal ultrasound.

Duplex kidney with calculus obstruction of lower moiety lessons learnt.

Duplex kidneys are one of the commonest congenital malformations of the urogenital system that one comes across in urological practice. It can be complete or incomplete. Ureteral duplication is usually asymptomatic but can accompany by urinary infections, ureterocele, vesicoureteral reflux or other congenital complications. The presence of stone in one of the systems may sometimes pose a therapeutic challenge to the urologists, especially when they attempt to remove the ureteric stone endoscopically. We report a 33-year-female who presented with acute left ureteric colic. Axial imaging revealed a large distal ureteric calculus. During ureteroscopy, no calculi were seen in the entire course of ureter upto renal pelvis. Screening with an image intensifier revealed a stone adjacent to the line of ureteroscope, raising suspicion of a duplex system or radio-opaque shadow outside the lumen of ureter. On further evaluation, a mucosal elevation with oedema was seen above and lateral to the ureteric orifice, raising suspicion of complete duplication of the ureter with pseudo ureterocele. However, no other ureteric orifice was observed. Deroofing of the edematous mucosa revealed the underlying large ureteric calculus. Retrograde pyelogram confirmed a duplex system and two ureters with stone in the upper moiety. Our report highlights the unusual presentation and the hard lessons learnt. It is prudent to search for accessory ureteric orifice especially when stone is not seen during ureteroscopy but seen under image intensifier. Keywords: Duplex Kidney, Urolithiasis, Hydronephrosis, Ureterocele.

Penile duplication or diphallia: case report of a very rare disease

Diphallia or penile duplication is an extremely rare congenital malformation. The presentation of penile duplication and the number of other associated anomalies, range from a double glans from a penis with no associated anomaly up to complete penile duplication associated with multiple anomalies.

Complete diphallia: How to proceed?

Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication. We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed a normal urethra in the right penile and stricture at glandular and mid penile urethra of the left penis. A Y confluence to bulbar urethra was observed confirming only one prostate and bladder. The cystoscopy through the right penile identified the urethral confluence in the bulbar area. We performed a meatotomy in the left penile to insert the cystoscope and confirmed the blind ending urethra. We decided to remove this penile. The penile was degloved entirely and clamped and took out the corpora at the base. Diphallia can have three presentations: only glans duplication, bifid diphallia and complete diphallia (two corpora cavernosa and a corpus spongiosum for each penile). In our case, each penile presented only one corpora cavernosa and the decision taken was based on urethral patency. The treatment should always be planned individually whereas associated anomalies with the goal of attaining satisfactory functional and cosmetic results.

Oesophageal duplication – An uncommon cause of dysphagia in an adult

Duplication of the oesophagus has ranges from complete duplication which is very rare to a partial cystic duplication (also known as duplication cyst). The oesophagus is the second most common site after the ileum to be involved with gastrointestinal duplication. It commonly manifests in neonates and children. The adults are usually asymptomatic. In this report, we describe a case of an adult male presenting with dysphagia because of a lower oesophageal duplication cyst. The diagnostic features and treatment options are discussed.

Lower pole anatomy of horseshoe kidney and complete ureteral duplication: Anatomic and radiologic study applied to endourology.

To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with complete ureteral duplication (CUD), in polyester resin endocasts of the collecting system and in patients submitted to 3D computerized tomography scan (CT-scan). We analyzed seven 3-dimensional polyester resin endocasts of the kidney collecting system obtained from 6 fresh adult cadavers (4 with unilateral CUD and 2 with horseshoe kidney) and CT-scan reconstruction images of kidneys from 24 patients: 6 patients with HK, 8 with CUD and 10 patients without renal anomalies that were used as controls. We analyzed the spatial distribution of the calices, the infundibula diameters, the angle between the lower infundibulum and the renal pelvis (LIP) and the angle between the lower infundibulum and the inferior minor calyces (LIICA). Measurements of the width and length of the inferior infundibulum and the infundibula of the minor calyces, as well as the angles (LIP and LIICA) were made with the aid of the LibreOffice 6.3 software. The data were analyzed with the IBM® SPSS® Statistics. There was no statistical difference in the inferior pole measurements between the groups with anomalies and the control group, both in polyester resin endocasts and CT-scan reconstruction images for LIP. When we compared the LIP in the CT-scan between HK versus CUD (p= 0.003), and HK versus the control group (p= 0.035), we observed statistical difference. The knowledge of spatial anatomy of lower pole is of utmost importance during endourologic procedures in patients with kidney anomalies. In the present study we observed that horseshoe kidneys had more restrictive anatomic factors in lower pole than the complete ureteral duplication.