Ureteral Duplication Research Articles

Surgical technique of uretero-ileal anastomosis in patients with bilateral duplex ureters undergoing radical cystectomy and ileal conduit urinary diversion: initial experience

Background We present a simple technique for construction of wide ureteral plate, consisting of four ureters, incorporated in ureteroileal anastomosis of ileal conduit urinary diversion. Methods We retrospectively reviewed the charts of six cases of ureteral duplication (five bilateral and one unilateral) and muscle-invasive bladder cancer, treated with radical cystectomy and ileal conduit diversion, at our institution from 2015 to 2020. Briefly, our technique includes construction of wide ureteral plate, consisting of four ureters from two separate ureteral units, after previous construction of right and left ureteral plates for each unit, according to the standard Wallace technique. Additionally, during construction of definite ureteral anastomotic plate, we used a modified Wallace I technique consisted of eversion of posteromedial ureteral walls of both ureteral units, with muco-mucosal running suture. Results Four males and two females underwent radical cystectomy with ileal conduit for muscle invasive bladder cancer. A total of 12 complications (CDC I–III) were registered in 4/6 (66.6%) patients, whereby ten of them (83.3%) occurred within 90 days post-surgery. High-grade (CDC III) complications were registered in 33.3% of patients. Within the first three months post-surgery, hydronephrosis and high-grade vesicoureteral reflux were associated with pyelonephritis and observed in two patients (33.3%), while uretero-intestinal anastomotic stricture or leakage were not detected during follow-up in any patients. Conclusion Modified Wallace uretero-ileal anastomosis after radical cystectomy and ileal conduit urinary diversion is functionally and cosmetically effective way to treat patients with bilateral duplex ureters harbouring muscle invasive bladder cancer.

Complete Bilateral Ureteral Duplication: A Case Study on Anatomic Variations

Developmental variation is frequently observed during anatomical study. Some variations remain asymptomatic and do not interfere with normal function but others may have significant clinical consequences. Developmental anomalies of the renal excretory system are not uncommon. Knowledge of the variation in ureteral development is essential in determining the management strategies of urogenital disorders. Partial or complete duplication of the ureter may result from early splitting of the ureteric bud or the presence of a second ureteric bud. Here we report a case of congenital anomaly in the ureterorenal system where complete bilateral ureteral duplication was found in a female cadaver donor. Both sets of ureters entered the urinary bladder enclosed in a common fascial sheath but opened separately into the trigone of the bladder. In this case, no evident renal pathology was observed. There was no sign of renal cysts, hydronephrosis or calculus in either kidney. This case highlights the importance of learning morphological variations to students of health science.

Assessment of distal ureteral and ureterovesical junction visualization on contrast-enhanced voiding urosonography.

Contrast-enhanced voiding urosonography (CEVUS) uses intravesically administered microbubble contrast to detect vesicoureteral reflux (VUR) and urethral anomalies with ultrasound. Multiple studies have suggested CEVUS can replace voiding cystourethrogram (VCUG) as a radiation-free alternative. Analysis of the ureterovesical junction and ureters on VCUG documenting the ureterovesical junction position, ureteral duplication, periureteral diverticula and ureteroceles is important as anatomical variations may affect management and surgical approach. Our purpose was to assess distal ureteral and ureterovesical junction region visualization in children with VUR detected on CEVUS. CEVUS studies performed between June 2018 and March 2019 with reported VUR were retrospectively reviewed by two pediatric radiologists to confirm VUR and to qualitatively assess the ureterovesical junction region for each renal moiety using a 3-point scale for clear, limited or absent visualization of the distal ureter, ureterovesical junction, ureteral duplication, periureteral diverticula and ureteroceles. Thirty-four studies with VUR on CEVUS were identified. Sixty-seven renal moieties were evaluated including a solitary kidney in one child. VUR was detected in 52 moieties by reader 1 and in 53 by reader 2. A single moiety with discrepancy between readers regarding VUR was excluded from statistical analysis. No diverticula were detected by either reader and one ureterocele was detected by both readers. Visualization of the ureterovesical junction was described as clear in 5/52, limited in 14/52 and absent in 33/52 refluxing renal moieties by reader 1 and as clear in 12/52, limited in 20/52 and absent in 20/52 by reader 2. The ureterovesical junction was clearly visualized in 5/52 (9.6%) by reader 1 and 12/52 (23.1%) by reader 2. The Kappa value of -0.29 (confidence interval [CI] -0.25, 0.21) reveals a lack of agreement between the readers for clear versus limited or absent ureterovesical junction visualization. Distal ureteral visualization was described as clear in 14/52, limited in 16/52 and absent in 22/52 refluxing renal moieties by reader 1 and as clear in 27/52, limited in 7/52 and absent in 18/52 by reader 2. The distal ureter was clearly visualized in 14/52 (26.9%) by reader 1 and 27/52 (51.9%) by reader 2. The Kappa of 0.43 (CI 0.22, 0.64) reveals moderate agreement between the readers for clear versus limited or absent distal ureteral visualization. Duplication of the renal collecting system was identified in 13/52 refluxing kidneys by reader 1 and 11/52 refluxing kidneys by reader 2. Visualization of ureteral duplication was described as clear in 9, limited in 4 and absent in 39 of 52 refluxing renal moieties by reader 1 and as clear in 9, limited in 2 and absent in 41 by reader 2. Ureteral duplication was clearly visualized in 9/52 (17.3%) by reader 1 and 9/52 (17.3%) by reader 2. Kappa of 0.87 (CI 0.68, 1) reveals high agreement between the readers for clear versus limited or absent identification of ureteral duplication. The distal ureter and ureterovesical junction region frequently are not clearly visualized in refluxing renal moieties on CEVUS. Awareness of this limitation is important as there may be implications when evaluating patients for surgical management of VUR.

The additive impact of the distal ureteral diameter ratio in predicting early breakthrough urinary tract infections in children with vesicoureteral reflux

Many factors influence patient and provider decisions to surgically correct vesicoureteral reflux (VUR), including risk of breakthrough febrile urinary tract infections and likelihood of spontaneous resolution. Ureteral diameter ratio has been shown in several studies to be more predictive than reflux grade with regard to breakthrough urinary tract infection (UTI). We developed and investigated the accuracy of a computational model for predicating febrile breakthrough urinary tract infection within 13 months of starting prophylactic antibiotics in children with VUR. The aim of this study was to validate a model for evaluating the impact of distal ureteral diameter ratio (UDR) in predicting early breakthrough urinary tract infections in children with VUR. Following a retrospective review, we recorded patient demographics, presenting symptoms, VUR grade, laterality, VUR during filling or voiding, initial bladder volume at the onset of VUR, ureteral duplication, voiding dysfunction, distal ureteral diameter ratio, and number of UTIs prior to VUR diagnosis. NeUROn++, a set of C++ programs, was used to model each data set using logistic regression and neural networks with different architectures. After exclusions, 136 children (93 girls and 43 boys) diagnosed with primary VUR had detailed VCUG and UDR data available. Fourteen children (10.3%) experienced breakthrough febrile UTI events within 13 months of VUR diagnosis. There was a significant association with UDR and breakthrough UTI (p=0.008). Various computational prediction models for the outcome of breakthrough UTI were developed and evaluated. The computational model that fit best was a model using all variables with an ROC of 0.802. Clinicians and parents often opt for intervention based on likelihood of spontaneous resolution of VUR as well as clinical course, thereby placing an emphasis on the ability to predict likelihood of breakthrough UTI infections. Our statistical analysis and prediction models further confirm UDR as an important variable predictive of breakthrough UTIs within the first 13 months of beginning prophylactic antibiotics. Furthermore, we developed a neural network model incorporating UDR and grade with an ability to yield the greatest accuracy of any breakthrough UTI predictive calculator to date at 80%.

Unilateral Bifid Ureter with Persistent Left Superior Vena Cava: A Cadaveric Case Report

This is a case report of unilateral bifid ureter with Double Superior Vena Cava (DSVC) which was observed during the routine dissection on a 60-year-old male cadaver. The finding is of interest due to the presence of urogenital and vascular anomalies. The case belonged to the category of incomplete double renal pelvis and ureter along with a Persistent Left Superior Vena Cava (PLSVC) with an enlarged coronary sinus and a normal Right Superior Vena Cava (RSVC). Incomplete double ureter with the angled point of junction of the two ureters creates a narrowing that can further obstruct normal flow, predisposing to uretero-ureteric reflux and associated complications such as hydronephrosis, as well as increases the possibility of ureteral injury during surgery. PLSVC is usually an insignificant finding, however, its presence makes it difficult for insertion of central venous catheter via left internal jugular vein and is important to surgeons and interventionalists.

Successful Management of Renal Fusion Anomaly of Kidney with Nephrolithiasis and Urinary Incontinence

The presence of an ectopic ureter may be indicated by continuous wetting, seen especially in girls. In majority of such cases, an ectopic ureter is associated with a duplex collecting system and complete ureteral duplication. A 32-year-old female presented with urinary incontinence with normal voiding episodes and right flank pain. On investigation, she was found to have duplex moiety on the right-side with partially duplicated ureter and quadruple moiety on the left-side with partially duplicated quadruple ureter with ectopic opening of ureters. The patient also had right upper calyceal stone. It was successfully managed with totally minimal invasive technique with retrograde intrarenal surgery for right nephrolithiasis and left laparoscopic ureteric reimplantation for ectopic ureter. Patient was continent during the follow-up period of nine months with no significant complications. Developmental anomalies of kidney and ureter though rare, can be managed with total minimal invasive techniques, requires proper planning, instruments and its implementation.

Коррекция пороков уретеровезикального сегмента при полном удвоении верхних мочевыводящих путей у детей

Ureteral duplication is often accompanied by such malformations as vesicoureteral reflux, megaureter, ureterocele and extravesical ureteral ectopia. The least traumatic transurethral interventions have been developed, but, unfortunelly, these kind of treatment have limited indications and effectiveness. In the presence of contraindications to transurethral methods or negative results of their use, urologists have until recently been forced to return to traditional open surgical operations. The desire to reduce trauma has led to the development of laparoscopic methods for correcting malformations of the ureterovesical segment, combining the high efficiency of surgical operations with less traumatic transurethral methods of treatment. In the review we have built up national and international research experience about the treatment of the pathological conditions in duplex upper urinary tracts, including the use of open operations, endoscopy and endosurgery. The results of low-traumatic transurethral interventions and the results of various variants of the formation of ureterocystoanastomosis are considered. Numerous publications indicate that, with the same effectiveness, less traumatic laparoscopic techniques are now becoming the preferred methods of treating malformations of the ureterovesical segment in children. At the same time, there is a certain lack of information on their use with complete ureter duplication, which determines the relevance of continuing research in this direction. Key words: duplication, laparoscopy, megaureter, review, ureterohydronephrosis, urology, vesicoureteral reflux

A Novel Technique for Management of Simultaneous Fibro-Epithelial Polyp and Blind-Ending Branch in a Duplicated Ureter: A Case Report With 23-year Follow-Up

Ureteral duplication with a blind-ending branch (BEB) is rare anomaly. The presence of fibro-epithelial polyps in duplicated ureters is also infrequent. Despite the noticeability of endoscopic polypectomy, further recurrence of polyps and persistence of pain increase the probability of further ureteral resection with surgical procedures. In such cases, BEB of duplicated ureter is an excellent reservoir to save the function of the kidney. This is the first case with concomitant presence of fibro-epithelial polyps and BEB in duplicated ureter managed with novel surgical technique of uretero-pelvic junction and BEB branch anastomosis. We followed-up the patient for 23 years.

VE13 - Robot-assisted laparoscopic ureteroureterostomy for injury of an complet ectopic duplicated ureter following robotic radical prostatectomy

VE13 - Robot-assisted laparoscopic ureteroureterostomy for injury of an complet ectopic duplicated ureter following robotic radical prostatectomy

Duplicated Collecting System

Study Objective The objective of this video is to discuss the presentation, evaluation, and treatment of duplicated urinary collecting systems, and to present a case of duplicated ureters with ectopic ureteral implantation at the vaginal introitus. Design N/A Setting N/A Patients or Participants We present the case of a 56 year-old presenting with a history of recurrent urinary tract infections starting in adolescence. She reported symptoms of urinary urgency, frequency, and incontinence. She additionally reported an unclear history of an incidental diagnosis of ureteral anomaly in childhood. Interventions For evaluation of this patient, a computed tomography urogram was performed which revealed a right duplicated kidney with upper ureter inserting into the bladder neck, and lower ureter with unclear course. A voiding cystogram was performed to evaluate for ureteral reflux which was not demonstrated. A renal MAG3 scan was performed and demonstrated differential function between the two right renal moieties but no evidence of obstruction to the outflow tract to either renal moiety. Exam under anesthesia, cystoscopy, and right retrograde pyelogram revealed an ectopic ureteral orifice at the vaginal introitus and mild hydroureter leading to the upper renal moiety. Measurements and Main Results Complete mapping of this patient's right collecting system revealed complete ureteral duplication with the lower renal moiety drained by a normal ureter leading to an orthotopic ureteral orifice and the upper renal moiety draining into a mildly dilated ureter leading to an ectopic ureteral orifice at the vaginal introitus. The patient will subsequently undergo robotic-assisted right ureteroureterostomy and excision of distal ectopic ureter in a combined laparoscopic and vaginal approach. Conclusion Duplicated urinary collecting systems are the most common birth defect related to the urinary tract and can be frequently encountered by the pelvic surgeon. Knowledge of the presentation and workup of these anomalies is important in determining appropriate treatment.

Clinical Observation of Double Percutaneous Nephrostomy Combined with Ureter Occlusion Stent for Treating Cervical Cancer Complicated with Vesicovaginal Fistula.

Background: To evaluate the efficacy of double percutaneous nephrostomy (PCN) combined with ureter occlusion stent for treating cervical cancer complicated with vesicovaginal fistula (VVF). Materials and Methods: A retrospective analysis was performed for 12 patients with cervical cancer complicated with VVF. Regardless of surgical resection, radiotherapy alone or combined chemoradiotherapy were carried out in all patients. After VVF was diagnosed by gynecological examination, imaging, and cystoscopy, concurrent double PCN and ureter occlusion stent implantation were performed for all patients. Results: All patients successfully received ureter occlusion stent implantation after nephrostomy. The success rate of nephrostomy and stent placement was 100% (12/12). After intervention, urinary fistula immediately disappeared in all patients. One week post-surgery, bilateral hydronephrosis disappeared in 4 patients, and their renal insufficiency and renal function returned to normal. One month after operation, 6 patients with genital eczema or ulcer and 5 patients with urinary tract infection were cured. During follow-up, there were no recurrence in urinary fistula, renal dysfunction, and other complications. Conclusion: Double PCN combined with ureter occlusion stent could effectively treat cervical cancer complicated with VVF hydronephrosis, urinary tract infection, and renal insufficiency and contribute to alleviate all kinds of clinical discomfort.

Duplication of Ureter in the Cadaveric Dissection: A Systematic Review

Duplication of Ureter in the Cadaveric Dissection: A Systematic Review

Efficacy of the Endoscopic Combined Intrarenal Surgery for the Treatment of a Staghorn Calculus in Crossed Fused Renal Ectopia

Background: Crossed fused renal ectopia (CFRE) is an unusual anomaly in which both kidneys lie fused on one side, with double pelvis and ureters draining into both sides of the bladder. Complex renal stones are a considerable challenge to endourologists, and when a staghorn stone is associated with abnormal anatomy, its treatment is even more difficult. Today there is no consensus about the right treatment for complex renal stones in CFRE. So, the objective of this case is to present the efficacy of the endoscopic combined intrarenal surgery (ECIRS) for the treatment of a staghorn renal stone in one patient with CFRE. Case Presentation: We described a case of a 23-year-old man with prolonged lasting and pain on the left flank associated with intermittent gross hematuria. Enhanced CT revealed a crossed fused kidney on the left side, drained by an intercommunicating pelvis and a single ureter, with a staghorn stone wholly occupying both renal units. The patient was effectively treated by one single session of ECIRS. Conclusion: The ECIRS is a good alternative to consider in patients with CFRE that have a staghorn calculus with a reasonable success rate.

A rare case of herniated duplex collecting system causing obstructive uropathy

BackgroundAn inguinal hernia is the protrusion of intraabdominal organs through an opening in the abdominal wall. Structures such as small and large intestines are commonly contained within inguinal hernias. However, uretero-inguinal hernia of the native collecting system is an extremely rarely reported entity. If unrecognized, acute kidney injury due to obstructive uropathy or serious intraprocedural ureteral injuries during hernia repair can occur. A duplex collecting system is a congenital kidney anomaly with an incidence of 0.8%. A uretero-inguinal hernia involving duplicated ureters has not been previously described in literature. Here we report a case of obstructive uropathy secondary to uretero-inguinal hernia involving duplicated ureters.Case presentationA 78-year-old male known to have a left sided inguinal hernia presented to the Emergency department with two weeks of intermittent suprapubic tenderness, dysuria, frequency, urgency, frothy urine as well as nausea and vomiting. Workup on admission revealed an elevated creatinine of 2.8 mg/dl. CT imaging revealed duplicated left sided ureters with left inguinal hernia containing the ureters. There was cystic ureteral dilation within the herniation sac as well as moderate left hydroureteronephrosis. Patient had an elective inguinal hernia repair with left ureteral stent placement. Following the surgery, he had recovery of kidney function to the previous baseline serum creatinine of 1.5 mg/dl.ConclusionA duplex collecting system arises when two ureteral buds are formed during fetal development. However, diagnosis can be made in rare instances during adulthood when duplex collecting systems are usually found incidentally. Uretero-inguinal hernias have been reported as a common complication of renal transplant. However, uretero-inguinal hernias in native kidneys are considered an uncommon finding, especially with a duplex collecting system. When patients present with herniation and acute kidney injury, it is important to rule out the possibility of uretero-inguinal hernia to minimize complications such as obstructive uropathy and kidney failure. CT scan providing cross-sectional imaging is the ideal modality for identification of the site and etiology of urinary tract obstruction and site of herniation. If during imaging, an obstructive uropathy is observed, a nephroureteral stent or nephrostomy tube can be inserted to protect the ureter as well as relieve the obstruction, respectively.

Management of a Donor Supernumerary Kidney During Renal Transplantation: A Case Report

Introduction: A fused hilar supernumerary kidney was discovered in a donor organ upon reperfusion during renal transplantation. There is a paucity of literature regarding this anomaly and its management in renal transplant recipients. Case Presentation: Back table preparation of a right deceased donor kidney revealed a duplicated renal artery and ureter. Complex reconstruction of the vasculature was performed avoiding extensive hilar dissection. Following anastomosis of the renal vasculature to the recipient’s iliac vessels, reperfusion revealed a suspicious lower pole renal mass. Frozen section biopsies of the mass were consistent with normal renal parenchyma. Urology was consulted intraoperatively and confirmed the mass to be a small accessory kidney with a separate collecting system, thin parenchyma and hydroureteronephrosis. A nephrectomy of the supernumerary kidney was performed. Discussion: Supernumerary kidneys are extremely rare and infrequently encountered by transplant surgeons. They are usually asymptomatic and incidentally discovered on imaging. If discovered intraoperatively careful inspection must be performed to evaluate for stigmata of potential complications. Conclusion: Knowledge of this entity is important to provide crucial intraoperative decision making and management if encountered in a donor organ. Careful evaluation of these anomalies must be performed when considering resection in order to avoid later complications, with caution that resection may compromise renal function.

Squamous cell carcinoma of the renal pelvis with an associated double ureters-rare case report

Squamous cell carcinoma is rare in the renal pelvis and kidney than in the lower urinary tract. Mostly it is associated with renal stone. Here a case report of a 72-year-old male who presented with renal mass was reported. Radical nephrectomy was done, shows a tumor involves the middle pole and extends into the renal pelvis. The hilar surface shows the presence of double ureters. Histopathological examination showed a well-differentiated squamous cell carcinoma in the renal pelvis and one of the ureter. Tumor involves more than 50% of the renal parenchyma. There is also squamous metaplasia of lining epithelium of smaller length ureter seen. No evidence of urothelial dysplasia noted in the renal pelvis and both the ureters. Adjacent renal parenchyma, glomeruli show focal segmental glomerulosclerosis with mild Interstitial fibrosis and tubular atrophy(IFTA). Medium size vessels show intimal thickening and mucoid change. The final diagnosis of squamous cell carcinoma of the renal pelvis and smaller ureter infiltrating renal parenchyma, possibly secondary to the risk factor of the double ureter.

Double Ureter: Incidence, Types, and Its Applied Significance-A Cadaveric Study.

IntroductionCongenital ureter anomalies such as double ureters are uncommon developmental anomalies of the renal system. An abnormal branching pattern of ureteric bud results in the formation of double ureter. This study examined the incidence of double ureter in cadavers of a South Indian population.MethodsA total of 50 kidney and ureter specimens were carefully dissected out of the posterior abdominal wall and examined for the presence and subtype of double ureter.ResultsOf 50 kidneys, three (6%) specimens showed an incomplete double ureter, two on the right kidney and one on the left. In all three specimens, the double ureter fused at different levels to form a single ureter opening into the bladder. ConclusionsThe prevalence of incomplete double ureter is higher in this study compared with that in previous cadaveric studies. Ureteral injuries are a frequent complication of abdominal and pelvic surgeries. Hence, awareness about the types and varieties of double ureter will aid radiologists and surgeons in interpreting and diagnosing urological images and preventing accidental injury while performing surgery.

Transplantation of a Kidney With Duplicated Ureter Harvested From a Donor With Vascular Anomaly in the Form of Double Inferior Vena Cava: A Case Report

During the organ procurement procedure, a surgeon encounters anatomic anomalies not very often but also not uncommonly. These changes may put the success of the transplant into question. Despite the thorough diagnosis of the potential donor, these anomalies are often diagnosed during organ donation. In our paper we present a case of kidney transplantation with duplicated ureter. The organ was collected from a donor with duplicated inferior vena cava. After transplantation, the kidney functioned immediately. Taking into consideration the well-being of the recipient, organs with anatomic abnormalities should be carefully considered for transplantation. This is especially important when there is a constant shortage of organs for transplantation.

Left Bifid Ureter and Renal Artery Variation in an Adult Female Cadaver

During the retroperitoneal space dissection of a 77‐year‐old female cadaver, a left duplicated ureter (DU) was observed along with variations of left renal artery branching pattern. The ureter, typically 25–30cm in length, is a continuation of the renal pelvis that receives filtrate from 2 or 3 major calyces before entering the bladder. In this cadaver, two separate ureters that drained upper and lower kidney, with lengths of 12.4 cm and 10.6 cm respectively. The two ureters then joined to form a common ureter with a length of 12.7 cm before entering the bladder. There are two types of DU; this type of DU has been previously described as an incomplete or bifid ureter and is a commonly asymptomatic congenital abnormality of the kidney and urinary tract (CAKUT). However, it can produce symptoms of frequent urinary tract infections, urinary lithiasis, ureteric stenosis and renal colic (1). The incidence of any type of DU is 1 in 100 to 1 in 500 (2) and is also more common in women than men, with a ratio of 2:1 (1). Unusual blood supply of the left kidney was also observed with an aberrant left renal artery arising from the abdominal aorta 4 cm inferior to the left renal artery, crossing anterior to the DU and supplying the lower pole of the left kidney. The ovarian artery was observed arising from this aberrant left renal artery. The incidence of the gonadal artery arising from a source other than the abdominal aorta is approximately 20% (3). The incidence of an aberrant renal artery is observed in 20–30% of the population and has the potential to result in hydronephrosis (4).Support or Funding Information

V01-07 A RARE CASE OF PT3A CLEAR CELL RENAL CELL CARCINOMA IN A BIFID KIDNEY TREATED WITH ROBOTIC HEMINEPHRECTOMY

INTRODUCTION AND OBJECTIVE: Bifid, or divided-shaped kidney is relatively rare, with a reported incidence of 4%, of which 42% also demonstrate collecting system duplication. Malignant neoplasm accompanied by ureteral duplication is extremely rare with 24 cases reported in the literature. The majority of these reports were of urothelial carcinoma, and one case reported in the literature of a bifid kidney with papillary carcinoma. Here we present a case of a 42 year-old Hispanic female with the finding of a renal cell carcinoma involving only the upper pole of a bifid kidney with a completely duplicated collecting system. METHODS: The patient underwent a robotic-assisted laparoscopic left hemi-nephrectomy of the upper pole moiety of a bifid left kidney, with pathologic analysis demonstrating a 7.2 x 6.3 x 5.1cm clear cell renal cell carcinoma with invasion into a segmental branch of the renal vein. Intraoperative ultrasound was critical in the identification of the inferior border of the lesion to ensure complete excision along the isthmus dividing the upper and lower pole moieties. Indocyanine green was used to demonstrate re-perfusion and drainage of the remaining lower moiety of the bifid kidney at the completion of the procedure. RESULTS: There were no intraoperative or postoperative complications. Total robotic console time was 162 minutes. The intraoperative estimated blood loss was 400ml. Warm ischemia time was under 30 minutes. The patient was discharged home on postoperative day 2. Pre and post-operative eGFR were identical. Final pathologic analysis demonstrated a pT3a Fuhrman Grade 1 clear cell renal cell carcinoma with negative margins. CONCLUSIONS: Renal cell carcinoma of a bifid kidney with a duplicated collecting system is extremely rare. Here we demonstrate that a minimally invasive nephron sparing approach may be safely utilized in these cases. Pre-operative CT angiogram may be used in these cases delineate aberrant anatomy to minimize ischemia further. Further follow up to ensure oncologic outcome similar to partial nephrectomy in pT3a renal cell tumors will be necessary.Source of Funding: none