Duplex Collecting System Research Articles (Page 1)

Objective: To evaluate the role of Multidetector Computed Tomography (MDCT) in the detailed assessment, characterization, and classification of congenital renal anomalies along with associated complications. Study Design: Cross-sectional Descriptive study. Setting: Department of Radiology in the Institute of Urology and Transplantation (IUTR), Rawalpindi. Period: September 2023 to February 2024. Methods: A cohort of 38 patients aged 8 to 77 years was examined to investigate a spectrum of renal abnormalities. The diagnostic protocol comprised a comprehensive quad-phase examination using a state-of-the-art multi-detector-row CT scanner. The acquired images underwent meticulous evaluation by two experienced radiologists. Results: The mean age of the participants was 41.1 years. Among the 38 suspected cases, 24 exhibited normal kidney anatomy, while congenital renal anomalies were identified in 14 patients. Migration and fusion anomalies were observed in 5 patients, including 2 with crossed fused ectopia and 3 with horseshoe kidneys. Ectopic pelvic kidneys were diagnosed in 3 patients. Additionally, 2 patients presented with a duplex collecting system, one accompanied by a bifid ureter. Unilateral renal agenesis was found in 3 patients, with one female patient having a coexisting Mullerian duct anomaly. Conclusion: Multidetector CT (MDCT) emerges as a crucial diagnostic tool for congenital renal anomalies, offering insights into fusion, shape, and position abnormalities.

Minimally invasive partial nephrectomy versus open surgery in pediatric patients with duplex collecting system: A systematic review and meta-analysis.

There is a paucity of information and data on congenital anomalies of the kidney and urinary tract (CAKUT) in the African setting. The aim of this study was to determine the prevalence, pattern and distribution of CAKUT as observed from computed tomography (CT) scans in a black African population. This was a retrospective study carried out in Enugu, Southeast Nigeria. The study population was drawn from subjects who had an abdominopelvic CT scan or CT urography for either urological or non-urological conditions. Data was pulled from three large-volume referral centers for CT scans in the city center, and study period extended from January 2015 to December 2024. Analysis was performed using Statistical Package for Social Sciences (IBM Corp., Armonk, NY, USA) for Windows, version 27.0. Data were described using frequencies and proportions in tables and charts. The records of 3507 subjects were retrieved for this study. A total number of 122 subjects had congenital anomalies of the kidneys or the urinary tract, which gave a prevalence of 3.5% (95% confidence interval: 2.9-4.1%). The mean age of subjects was 39 ± 19.8 years and the majority of them were males (57.4%). The most prevalent anomaly was pelviureteric junction (PUJ) obstruction (1.28%), followed by duplex collecting system. The prevalence of CAKUT from this study was 3.5%. Pelvic ureteric junction obstruction was the most prevalent congenital anomaly of the urinary tract in our setting.

Recent studies suggest a possible association between variants in SETD5 and epilepsy, particularly in individuals with intellectual disability and developmental delay. However, the current understanding of SETD5 function in epilepsy is limited. We describe a 6-year-old girl harboring a pathogenic SETD5 gene variant, disclosed in early infancy by whole exome sequencing that was performed for global developmental delay. Her neurologic phenotype evolved during follow-up to include focal and generalized seizures as well as an overt neurodevelopmental disorder, characterized by receptive-expressive language difficulties with speech disorder and mild cognitive impairment. Her clinical picture was also characterized by recurrent urinary tract infections in a duplex collecting system due to a concomitant and unrelated GREB1L gene variant. Our findings confirm that epilepsy may arise after SETD5 variants, with subtle clinical manifestations that may overlap with behavioral phenomena in children who also exhibit cognitive and behavioral comorbidities.

Bilateral duplex system with ureteroceles is one of the rarest entities in urology. Duplex collecting system is a common urologic anomaly with a wide range of clinical symptoms and a variety of associated urologic abnormalities such as an ectopic ureter, ureterocele, vesicoureteral reflux and ureteropelvic junction

A duplicated collecting system, characterized by the presence of two separate pelvicalyceal systems within a single kidney, is a rare congenital anomaly. Surgical intervention, such as open heminephrectomy, is often required in cases where complications arise, including recurrent infections, significant obstruction, or reflux. We report the case of a 29-year-old female who presented with recurrent urinary tract infections and flank pain with reflux. Imaging studies revealed a duplicated collecting system on the right side with significantly poor functioning upper moiety while preserving the healthy lower moiety. The patient tolerated the procedure well, with no intraoperative complications. Postoperative recovery was uneventful, and follow-up imaging confirmed the successful removal of the affected renal segment. The patient remained symptom-free at the two-month follow-up. Open heminephrectomy remains a viable surgical option for managing a symptomatic duplicated collecting system.

Our study aims to explore the association of duplex collecting systems with variable renal vasculature and renal calculi, given the paucity of published data on the subject. Between 2020 and 2023, retrospective research on patients with a duplex collecting system detected by CT scans was conducted at the radiology department of Shifa International Hospital. We assessed any gender bias and ascertained the frequency of this unilateral or bilateral duplex system abnormality. Furthermore, in patients who had received post-contrast imaging, the prevalence of renal calculi and varied renal vasculature was evaluated. In individuals with a duplex collecting system, the correlation between renal stones and renal variant vasculature was computed. SPSS version 25 was used to conduct the chi-square test. We retrospectively gathered data on patients with duplex collecting systems that showed only 65 patients. According to our research, bilateral participation is uncommon but the duplex collecting system is not side-specific. According to our statistics, this aberration has been more common in men as compared to women. Only 36 of the 65 patients in total had post-contrast imaging to check for variances in the vasculature. Of the 36 patients with renal vein variations, 11 had renal vein variations and 25 did not have any anatomical variations. Of the 25 individuals who did not have a renal vein variation, 19 did not have calculus, 2 had calculus involving the lower pole, and 4 had calculus involving the upper pole. 8 individuals with renal variations did not have renal calculus, 2 patients had lower pole calculus, and 1 patient had upper pole calculus. A negative uncertainty coefficient was seen between renal vein vasculature and calculus formation. 17 of the 36 patients had renal artery variations, whereas 19 patients had no anatomic variation of the renal artery. 12 of the 19 individuals without a renal artery variation had no calculus, 2 had calculus involving the lower pole, and 5 had calculus involving the upper pole. 2 individuals had calculus affecting the lower pole, 0 patients had calculus on the upper pole, and 15 patients with renal artery variations had no renal calculus. A positive uncertainty coefficient was seen between renal arterial vasculature and calculus formation. Understanding renal vasculature patterns is vital for effective vascular interventions as well as kidney transplantations. Patients with a duplex collecting system are at increased risk of stasis, infections, and stone formation. For urologists and nephrologists, awareness of the association with variant renal vasculature is critical for managing complications related to this anomaly.

Wilms' tumor (WT), also known as nephroblastoma, is a malignant embryonal kidney tumor composed of embryonic cells and is the most prevalent tumor among children, but isolated cases occur infrequently in the adult population. Adult WT is defined according to the criteria of Kilton, Matthews, and Cohen, which comprise age above 15 years and histological patterns characteristic of WT. We report a case of an adult WT with venous thrombus on an incomplete duplex collecting system. To the best of our knowledge, this is the first case of adult WT with such a presentation. A 28-year-old female patient presented to our department with a 4-month history of right flank pain and flank mass and was diagnosed by abdominal contrasted CT to have a right renal tumor with tumor thrombi in the renal vein and the inferior vena cava. The CT scan also revealed a bilateral duplex collecting system with a partial (ureter fissus proximalis) on the tumor side and a complete duplex system on the contralateral side. Right radical nephrectomy with complete tumor thrombectomy via venacavotomy was performed successfully. Histopathological examination of the specimen revealed a triphasic nephroblastoma with immunohistochemistry confirmation. Postoperatively, adjuvant chemotherapy was initiated. The increasing incidence of non-syndromic WT cases associated with duplex collecting systems suggests a potential shared pathogenesis, necessitating further research.

Duplex Collecting System with Ureteric Ectopia Insertion into Vagina

This study aims to examine the role of intravenous pyelography (IVP) in the evaluation of developmental renal anomalies. A prospective cross-sectional study was conducted on 26 subjects presenting with loin pain and suspicion of renal anomalies, subjected to IVP at ACS Medical College and Hospital, Chennai. Descriptive statistics were used for frequency and percentage. The study population consisted of 61.5% males and 38.5% females, indicating a male predilection for renal anomalies. Horseshoe kidney (31%) and duplex collecting system (23%) were the most prevalent anomalies, underscoring the importance of early detection and tailored management. Less frequent anomalies included malrotation, ectopic kidney, crossed renal ectopia, and unilateral renal agenesis. Despite advancements in imaging technology, IVP remains relevant for detailed anatomical and functional assessment of the urinary tract. This study highlights the importance of proactive management and multidisciplinary collaboration in optimizing outcomes for patients with developmental renal anomalies.

BackgroundPrimary mucinous adenocarcinomas of the kidney are rare and pose a challenge for preoperative diagnosis. The histogenesis of these tumours remains largely unknown, with three proposed theories: chronic irritation, differentiation of celomic epithelium, and kidney maldevelopment. Here, we present two cases of renal mucinous adenocarcinoma in patients with developmental renal anomalies, specifically a duplex collecting system and a horseshoe kidney.Case PresentationFirst, A 50-year-old male presented with loin pain and jelly-like discharge in urine with a duplex collecting system and gross hydronephrosis of the upper moiety on imaging. The patient underwent upper polar nephrectomy with controlled drainage of 1.5 L of mucinous fluid. Histopathology was suggestive of mucinous borderline cystic neoplasm with invasive microcarcinoma. The patient presented one year later, with a hydronephrotic lower moiety of the left kidney and a rectus abdominis mass. Fine needle aspiration biopsy of the mass revealed papillary adenocarcinoma with histological resemblance to the renal pelvis lesion, establishing it as a metastasis from the primary renal malignancy. Second, A 53-year-old male who had undergone right laparoscopic cyst deroofing for a symptomatic renal cyst, whose postoperative histology revealed findings consistent with mucinous adenocarcinoma, presented with flank pain and palpable retroperitoneal mass. Imaging revealed a horseshoe kidney morphology with a large multilobulated hypodense non-enhancing cystic lesion arising from the right kidney. Cyst excision with right open radical nephrectomy was performed. Gross examination revealed multiple cystic spaces replacing renal parenchyma, filled with gelatinous material. Microscopy was suggestive of recurrent mucinous adenocarcinoma.ConclusionsRenal mucinous cystadenocarcinomas can be associated with anomalous kidneys. Definitive diagnosis relies on histopathology, and these tumours are recognized for their aggressive nature. Complete resection is the preferred treatment, but further studies are needed to assess the efficacy of adjuvant treatment, given the poor prognosis and high likelihood of recurrence.Clinical trial numberNot applicable.

Introduction: Most people with ureteral duplications never experience any symptoms, so the condition goes unreported despite being one of the most prevalent kidney anomalies. Case: A 31-year-old female visited our medical facility for a routine checkup. Kidney function and complete urine analysis were normal. Ultrasonography revealed what appears to be a duplex collecting system in the right kidney, with two distinct noncommunicating renal pelvices. A 3D computed tomography (CT) scan of the abdomen with contrast revealed a duplex collecting system in the right kidney. Conclusion: Radiologists play a crucial role in detecting these abnormalities.

Abstract The usual opening of the ureters is in the trigone of the bladder. However, it may open in an infrasphincteric location causing urinary incontinence with normal voiding. This is more commonly associated with a duplex collecting system in females, albeit, a bilateral occurrence of ectopic ureters with drainage into the vagina is rare. We report a rare case of bilateral occurrence of a duplex collecting system with drainage into the vagina. She was a 3-year-old girl with a complaint of continuous dripping of urine despite normal voiding. There was no history of fever, difficulty with micturition, fecal soiling, back swelling, or pelvic surgery in the past. She had normal female external genitalia with two openings in the vestibule. A computerized tomography urography showed a bilateral duplex collecting system with prompt and symmetric excretion of contrast, and dilated ureters of the upper renal moiety draining into the vagina bilaterally. We reimplanted the ectopic ureters with a resolution of urinary incontinence.

Ectopic ureter and ureterocele need an adequate treatment plan and different surgical interventions. However, some cases appear as intravesical cystic lesions on ultrasound, with ectopic ureter sometimes reported as pseudoureterocele. This study aimed to describe the sonographic imaging findings of intravesical cystic lesions to differentiate between pseudoureterocele and ureterocele. Nineteen patients with duplex collecting system and intravesical cystic lesions that were classified into pseudoureterocele and ureterocele based on the surgical findings were included. The ultrasound findings compared between the 2 groups were as follows: intravesical lesion with/without a covered muscular layer, presence/absence of notch sign within the lesion, and dynamic change in the appearance of intravesical cystic lesions using Fisher's exact test. The lesions in 3 patients were classified as pseudoureterocele due to ectopic ureter and the remaining 16 as ureterocele. Significant differences were observed in intravesical lesions with/without a muscular layer (pseudoureterocele versus ureterocele = 3/0 versus 3/13, P = .021) and the presence or absence of a notch sign within the vesical cystic lesion (pseudoureterocele versus ureterocele = 3/0 versus 3/13, P = .021) between the groups. Although there was a tendency for the dynamic change in the appearance of intravesical cystic lesions to be more detectable in cases with ureterocele than in pseudoureterocele, the difference was not significant (0/3 versus 11/5, P = .058). Sonographic findings, including bladder muscular layer location and the presence of a notch sign within the cystic lesion, were useful in differentiating pseudoureterocele and ureterocele in intravesical cystic lesions in pediatric patients with a duplex collecting system.

Identification of urological anomalies associated with anorectal malformation in southwestern Uganda: Limitations and opportunities

Outcomes of robot-assisted laparoscopic pyeloplasty among pediatric patients with complex renal anatomy: A retrospective comparative study

This study aims to describe the MRI findings of six patients with ectopic ureters in a tertiary care institute. A retrospective analysis was conducted on six patients presenting to the Department of Radiodiagnosis at Sawai Man Singh (SMS) Hospital, Jaipur, India, with ectopic ureters. Data were collected from the 3 Tesla (3T) Philips MRI scanner (Koninklijke Philips N.V., Amsterdam, Netherlands) from 2021 to 2023. The mean age was 21.6 years, with an equal male-to-female ratio (1:1). Most patients presented with urinary incontinence (50%, n = 3), followed by abdominal pain. Only 16.6% (n = 1) were associated with a duplex collecting system. In males, the most common site was the seminal vesicle, observed in 66.6% (n = 2), followed by the urethra in 33.4% (n = 1) of cases. One patient with an ectopic opening into the seminal vesicle had Zinner syndrome. In females, the ectopic site was found to be the vagina in all three patients. Ectopic ureter is a rare anomaly of the urinary system, often associated with other urinary system anomalies and a few syndromes. Clinical presentations range from the patient being asymptomatic to renal failure; therefore, a high index of suspicion and appropriate imaging are necessary for early diagnosis and timely treatment.

Upper tract urothelial carcinoma (UTUC) in a duplex collecting system (DCS) is a relatively uncommon presentation with unclear management guidelines. Herein, we retrospectively reviewed all published cases of DCS with UTUC aiming to suggest personalized clinical care options for future cases. We conducted a systematic search for all cases of UTUC in DCS from published literature using the following keywords: UTUC, urothelial carcinoma (UC), collecting duct carcinoma, and DCS. The cases were summarized based on demographics, clinical presentation, predisposing risk factors, tumor location, management, and follow-up. We present an additional case based on our experience with a 69-year-old female with high-grade (HG) UTUC of the upper moiety in complete DCS. The patient underwent a robotic upper pole hemi-nephroureterectomy (hemi-NU) with a common sheath distal ureterectomy and a bladder cuff, followed by lower pole ureteral reimplantation. Overall, 34 patients with 35 renal units of UTUC in DCS were included and analyzed. To conclude, UTUC of DCS is rare and underreported. Hence, it is difficult to define a standard treatment. Although hemi-NU has been previously described, to the best of our knowledge, this is the first case report of robot-assisted hemi-NU for complete DCS with single-moiety UC.

Background: The definition of ectopic ureter is an abnormal opening of the ureter (single or duplex) that does not open in the trigonal region of the bladder. In 80% of these cases, ectopic ureter is associated with complete duplication. The upper moiety of a duplex kidney is usually the origin of a ectopic ureter in most of the cases. The opening of the ectopic ureteric in females can be anywhere from bladder neck to perineum with urethra, vagina, and vestibule. Duplex kidney, also known as duplex collecting system, is a common congenital urinary system anomaly with a morbidity of about 0.8–1%. We present a unique case of a completed duplicated system with ectopic ureter opening into the uterus leading to a non-functional associated upper renal moiety of the affected side which was managed by robotic assisted segmental nephrectomy. Case presentation: We present a case of 52-year- old lady who presented to urology outpatient department with complaints of sticky white perineal discharge through vaginum associated with left sided intermittent colicky flank pain who was diagnosed to have complete duplex left moiety with ectopic insertion of the upper moiety ureter into the vagina associated with non-functioning left upper renal moiety. She was managed by robotic assisted Left sided heminephrectomy with excision of left ectopic ureter. Conclusion: Our case report thus highlights the importance of adequate evaluation of a patient to determine the anatomy and the function of the kidney to decide for the definitive management of these patients with ectopic ureter and duplex kidneys.

Minimally invasive treatment of pediatric obstructive ureterocele: A 20-year experience