CLINICAL EXPERIENCE IN DIAGNOSIS AND MANAGEMENT OF COMPLETE DUPLICATION OF KIDNEY AND URETER IN 106 CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZENGLi , HUANGGuizhen , ZHANGJie , KANGLei , HUANGYidong , YUANMiao ,  HUANGLugang

Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

HUANGLugang, Email: lugang992001@aliyun.com

Keywords：

Duplication of kidney and ureter; Ureteral stump syndrome; Hydronephrosis; Ectopic ureteral orifice; Ureterocele; Ureterostenosis; Children

DOI：

10.7507/1002-1892.20150302

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Objective To discuss the clinical classification and treatment protocols of complete duplication of kidney and ureter in children. Methods Between March 2000 and February 2015, 106 children with complete duplication of kidney and ureter were treated, and the clinical data were retrospectively analyzed. Of them, there were 11 boys and 95 girls, aged from 1 month to 11 years (mean, 3.5 years); one side was involved in 88 cases and two sides in 18 cases. They were divided into 4 types according to image examinations and clinical presentations:14 patients who needed no special treatment were classified into the first type, 15 patients who underwent reconstruction into the second type, 74 patients who underwent segment removal of renal dysplasia and subtotal excision of abnormal duplicated ureter into the third type, and 3 patients who underwent removal of the whole affected kidney and subtotal excision of whole ureter into the forth type. Results The patients were followed up 2 months to 14 years (median, 23 months). There was no deteriorating case in the first type. There was no complication such as leakage of urine, discomfort over the back and loins, ureterocele, reproductive tract infection, or hematuresis in the other types. The results of white blood cell count, renal function, and electrolyte presented no abnormality. One patient in the second type and 6 patients in the third type had ureteral stump syndrome; 1 patient in the second type and 3 patients in the third type had urinary tract infection; and 3 patients in the second type had mild hydronephrosis after operation. Conclusion It can obtain good clinical outcome to choose individualized treatment according to clinical classification of complete duplication of kidney and ureter, which can reserve effective renal units as much as possible and improves the patients' quality of life.

Citation： ZENGLi, HUANGGuizhen, ZHANGJie, KANGLei, HUANGYidong, YUANMiao, HUANGLugang. CLINICAL EXPERIENCE IN DIAGNOSIS AND MANAGEMENT OF COMPLETE DUPLICATION OF KIDNEY AND URETER IN 106 CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1408-1414. doi: 10.7507/1002-1892.20150302 Copy

1.	Gonzalez F, Canning DA, Hyun G, et al. Lower pole pelvi-ureteric junction obstruction in duplicated collecting systems. BJU Int, 2006, 97(1):161-165.
2.	Peters CA, Schlussel RN, Mendelsohn C. Ectopic ureter, ureterocele, and ureteral anomalies//Wein AJ. Campbell-Walsh Urology. 10th eds. Philadelphia:Saunders, 2011:3236-3261.
3.	Piaggio L, Franc-Guimond J, Figueroa TE, et al. Comparison of laparoscopic and open partial nephrectomy for duplication anomalies in children. J Urol, 2006, 175(6):2269-2273.
4.	黃澄如. 實用小兒泌尿外科學. 北京:人民衛生出版社, 2006:223-228, 242-254.
5.	Leyendecker JR, Barnes CE, Zagoria RJ. MR urography:techniques and clinical applications. Radiographics, 2008, 28(1):23-47.
6.	馬睿, 吳榮德, 崔秀芳, 等. 三維CT尿路成像對小兒重復腎輸尿管畸形的診斷價. 中華泌尿外科雜志, 2002, 23(12):731-732.
7.	陳善錫, 高源統, 項小嬋, 等. 重復腎、重復輸尿管畸形的CT尿路成像診斷及與B超、靜脈泌尿道造影的對比. 實用醫學雜志, 2014, 30(3):397-399.
8.	Asase D, Frank RG, Gerard PS, et al. Transitional cell carcinoma of the renal pelvis in an incompletely duplicated collecting system. N Y State J Med, 1993, 93(1):59-61.
9.	Hisataki T, Takahashi A, Taguchi K, et al. Sarcomatoid transitional cell carcinoma originating from a duplicated renal pelvis. Int J Urol, 2001, 8(12):704-706.
10.	姚世杰, 徐子強, 馬洪順. 重復腎囊性腎癌一例報告. 中華泌尿外科雜志, 2011, 32(11):765.
11.	Chen GM, Chen SW, Xia D, et al. Sarcomatoid carcinoma of the renal pelvis in duplex kidney. Chin Med J (Engl), 2011, 124(13):2074-2076.
12.	Liu GM, Ma HS, Li YM. Multilocular cystic renal cell carcinoma in lower pole moirty of a duplex kidney. Int J Surg Pathol, 2012, 20(6):613-617.
13.	曾莉, 單偉, 袁淼, 等. 重復腎輸尿管畸形保留上部腎手術一例報道. 中國修復重建外科雜志, 2012, 26(10):1280.
14.	John WB, George EK, Linda MD, et al. Operations for Ureteral Duplication//Hinman's Atlas of Pediatric Urologic Surgery. 2nd Ed. Philadelphia:Saunders, 2009:267-276.
15.	Decaluwe D, Chertin B, Puri P. Fate of the retained ureteral stump after upper pole heminephrectomy in duplex kidneys. J Urol, 2002, 168(2):679-680.
16.	Jayram G, Roberts J, Hernandez A, et al. Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney:a muiticenter review. J Pediatr Urol, 2011, 7(3):272-275.
17.	Lucan M, Lucan C, Moga S, et al. Retroperitoneoscopic upper pole heminephrectomy in complete duplication of the ureter:management of the distal ureter. Eur Urol Suppl, 2007, 6(2):301.
18.	Abouassaly R, Gill IS, Kaouk JH. Laparoscopic upper pole partial nephrectomy for duplicated renal collecting systems in adult patients. Urology, 2007, 69(6):1202-1205.
19.	Plaire JC, Pope JC 4th, Kropp BP, et al. Management of ectopic ureters:experience with the upper tract approach. J Urol, 1997, 158(3 Pt 2):1245-1247.
20.	Miyazato M, Hatano T, Miyazato T, et al. Retroperitonescopic heminephrectomy of the right upper collecting system emptying into an ectopic ureterocele in a 5-year-old girl:a case report. Hinyokika Kiyo, 2000, 46(6):413-416.
21.	Tugcu V, Bitkin A, Sonmezay E, et al. Transperitoneal versus retroperitoneal laparoscopic partial nephrectomy:initial experience. Arch Ital Urol Androl, 2011, 83(4):175-180.
22.	Chen Z, Tang ZY, Fan BY, et al. Retroperitoneoscopic upper pole nephroureterectomy in duplex kidney:focus on the role of dilated upper pole ureter. Urol J, 2014, 10(4):1046-1053.

1. Gonzalez F, Canning DA, Hyun G, et al. Lower pole pelvi-ureteric junction obstruction in duplicated collecting systems. BJU Int, 2006, 97(1):161-165.
2. Peters CA, Schlussel RN, Mendelsohn C. Ectopic ureter, ureterocele, and ureteral anomalies//Wein AJ. Campbell-Walsh Urology. 10th eds. Philadelphia:Saunders, 2011:3236-3261.
3. Piaggio L, Franc-Guimond J, Figueroa TE, et al. Comparison of laparoscopic and open partial nephrectomy for duplication anomalies in children. J Urol, 2006, 175(6):2269-2273.
4. 黃澄如. 實用小兒泌尿外科學. 北京:人民衛生出版社, 2006:223-228, 242-254.
5. Leyendecker JR, Barnes CE, Zagoria RJ. MR urography:techniques and clinical applications. Radiographics, 2008, 28(1):23-47.
6. 馬睿, 吳榮德, 崔秀芳, 等. 三維CT尿路成像對小兒重復腎輸尿管畸形的診斷價. 中華泌尿外科雜志, 2002, 23(12):731-732.
7. 陳善錫, 高源統, 項小嬋, 等. 重復腎、重復輸尿管畸形的CT尿路成像診斷及與B超、靜脈泌尿道造影的對比. 實用醫學雜志, 2014, 30(3):397-399.
8. Asase D, Frank RG, Gerard PS, et al. Transitional cell carcinoma of the renal pelvis in an incompletely duplicated collecting system. N Y State J Med, 1993, 93(1):59-61.
9. Hisataki T, Takahashi A, Taguchi K, et al. Sarcomatoid transitional cell carcinoma originating from a duplicated renal pelvis. Int J Urol, 2001, 8(12):704-706.
10. 姚世杰, 徐子強, 馬洪順. 重復腎囊性腎癌一例報告. 中華泌尿外科雜志, 2011, 32(11):765.
11. Chen GM, Chen SW, Xia D, et al. Sarcomatoid carcinoma of the renal pelvis in duplex kidney. Chin Med J (Engl), 2011, 124(13):2074-2076.
12. Liu GM, Ma HS, Li YM. Multilocular cystic renal cell carcinoma in lower pole moirty of a duplex kidney. Int J Surg Pathol, 2012, 20(6):613-617.
13. 曾莉, 單偉, 袁淼, 等. 重復腎輸尿管畸形保留上部腎手術一例報道. 中國修復重建外科雜志, 2012, 26(10):1280.
14. John WB, George EK, Linda MD, et al. Operations for Ureteral Duplication//Hinman's Atlas of Pediatric Urologic Surgery. 2nd Ed. Philadelphia:Saunders, 2009:267-276.
15. Decaluwe D, Chertin B, Puri P. Fate of the retained ureteral stump after upper pole heminephrectomy in duplex kidneys. J Urol, 2002, 168(2):679-680.
16. Jayram G, Roberts J, Hernandez A, et al. Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney:a muiticenter review. J Pediatr Urol, 2011, 7(3):272-275.
17. Lucan M, Lucan C, Moga S, et al. Retroperitoneoscopic upper pole heminephrectomy in complete duplication of the ureter:management of the distal ureter. Eur Urol Suppl, 2007, 6(2):301.
18. Abouassaly R, Gill IS, Kaouk JH. Laparoscopic upper pole partial nephrectomy for duplicated renal collecting systems in adult patients. Urology, 2007, 69(6):1202-1205.
19. Plaire JC, Pope JC 4th, Kropp BP, et al. Management of ectopic ureters:experience with the upper tract approach. J Urol, 1997, 158(3 Pt 2):1245-1247.
20. Miyazato M, Hatano T, Miyazato T, et al. Retroperitonescopic heminephrectomy of the right upper collecting system emptying into an ectopic ureterocele in a 5-year-old girl:a case report. Hinyokika Kiyo, 2000, 46(6):413-416.
21. Tugcu V, Bitkin A, Sonmezay E, et al. Transperitoneal versus retroperitoneal laparoscopic partial nephrectomy:initial experience. Arch Ital Urol Androl, 2011, 83(4):175-180.
22. Chen Z, Tang ZY, Fan BY, et al. Retroperitoneoscopic upper pole nephroureterectomy in duplex kidney:focus on the role of dilated upper pole ureter. Urol J, 2014, 10(4):1046-1053.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL EXPERIENCE IN DIAGNOSIS AND MANAGEMENT OF COMPLETE DUPLICATION OF KIDNEY AND URETER IN 106 CHILDREN

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