Division of Pediatric Urology, Department of Urology, Mainz University Medical Center, Mainz, Germany.
Division of Pediatric Urology, Department of Urology, Mainz University Medical Center, Mainz, Germany.
J Urol. 2015 Aug;194(2):427-32. doi: 10.1016/j.juro.2015.01.095. Epub 2015 Jan 29.
Ureteropelvic junction obstruction in association with a duplex collecting system is a rare but challenging upper urinary tract pathology. We report our 21-year experience with this anomaly in terms of presentation, diagnostic evaluation and management.
We retrospectively identified all patients with ureteropelvic junction obstruction in a duplex collecting system between 1991 and 2012. We reviewed each case for presenting symptoms, anatomy and management. Median followup was 10.8 years (range 2 to 22).
Ureteropelvic junction obstruction in duplex kidneys was diagnosed in 21 patients. Ten patients presented with clinical symptoms such as flank pain and urinary tract infection but 11 were asymptomatic. Six patients were diagnosed by prenatal ultrasound. The lower pole and the upper pole were affected in 22 and 3 renal units, respectively. Bilateral ureteropelvic junction obstruction was found in 4 cases. Duplication was complete in 5 patients, incomplete in 11 and undetermined in 5. Surgery was performed in 14 patients, including pyelopyelostomy or ureteropyelostomy in 7, dismembered pyeloplasty in 6 and heminephrectomy in 1. Reintervention was required in 1 case. Conservative treatment was adopted in 7 patients with clinically insignificant obstruction and unimpaired renal function. In all of these patients upper urinary tract dilatation gradually improved during 3 years.
Ureteropelvic junction obstruction in a duplex kidney is a rare but challenging anomaly that requires careful evaluation. Treatment should be individualized according to clinical presentation (symptomatic/asymptomatic), anatomy (lower/upper pole), duplication type (complete/incomplete) and obstruction with time (severity/development) on dynamic renogram.
肾盂输尿管连接部梗阻合并双肾盂系统是一种罕见但具有挑战性的上尿路病理。我们报告了我们 21 年来在这种异常方面的经验，包括表现、诊断评估和管理。
我们回顾性地确定了 1991 年至 2012 年间在双肾盂系统中存在肾盂输尿管连接部梗阻的所有患者。我们回顾了每个病例的表现、解剖结构和管理情况。中位随访时间为 10.8 年（范围为 2 至 22 年）。
在双肾盂的 21 例患者中诊断出肾盂输尿管连接部梗阻。10 例患者表现为临床症状，如腰痛和尿路感染，但 11 例患者无症状。6 例患者在产前超声检查中诊断出。下极和上极分别受累 22 个和 3 个肾单位。4 例发现双侧肾盂输尿管连接部梗阻。5 例为完全性重复，11 例为不完全性重复，5 例无法确定。14 例患者接受了手术治疗，其中 7 例行肾盂肾盂吻合术或输尿管肾盂吻合术，6 例行肾盂离断成形术，1 例行半肾切除术。1 例需要再次干预。7 例临床表现不明显且肾功能未受损的患者采用保守治疗。在所有这些患者中，上尿路扩张在 3 年内逐渐改善。
双肾盂的肾盂输尿管连接部梗阻是一种罕见但具有挑战性的异常，需要仔细评估。治疗应根据临床表现（症状性/无症状性）、解剖结构（下极/上极）、重复类型（完全/不完全）和动态肾图上的时间（严重程度/发展）个体化。
