Kassir Rani, Ngamba Marie, Michel Jean-Luc, Zalzali Mohamad, Sauvat Frédérique, Renger Benoit
Department of Pediatric Surgery, CHU Félix Guyon, Allée des Topazes, 97400, Saint Denis, La Réunion, France.
Department of Urology, CHU Saint Pierre, Avenue du Président Mitterrand, 97448, Saint Pierre, La Réunion, France.
Int J Surg Case Rep. 2018;51:78-81. doi: 10.1016/j.ijscr.2018.07.048. Epub 2018 Aug 13.
Duplicated renal collecting system is one of the most common congenital upper urinary tract abnormalities. Duplex system with ectopic obstructive megaureter in the prostatic urethra is rare and exceptionally revealed in adulthood.
We present a rare case of a 72-year-old man without any previous history of urinary symptoms, admitted through the emergency department for altered general condition associated with fever for several days. Investigations have identified left complete duplex system and intraprostatic obstructive megaureter manifesting as acute pyelonephritis. The evolution of acute pyelonephritis was favorable under urine drainage by percutaneous nephrostomy tube and antibiotherapy. Given the multiple comorbidities of the patient, radical surgical treatment by left upper pole nephrectomy was ruled out and we opted for an iterative change of percutaneous nephrostomy tube.
We briefly review the pathophysiology, diagnosis and therapeutic aspects.
Early diagnosis and treatment of complicated duplex system is important. Urologists should keep this anomaly in mind.
重复肾集合系统是最常见的先天性上尿路异常之一。伴有前列腺尿道异位梗阻性巨输尿管的双肾盂系统罕见，且在成年期极少出现。
我们报告一例罕见病例，患者为72岁男性，既往无任何泌尿系统症状史，因数天来与发热相关的全身状况改变经急诊科入院。检查发现左侧完全性双肾盂系统及前列腺内梗阻性巨输尿管，表现为急性肾盂肾炎。经皮肾造瘘管引流尿液及抗生素治疗后，急性肾盂肾炎病情好转。鉴于患者有多种合并症，排除了行左肾上极肾切除术的根治性手术治疗，我们选择反复更换经皮肾造瘘管。
我们简要回顾了其病理生理学、诊断及治疗方面。
早期诊断和治疗复杂双肾盂系统很重要。泌尿外科医生应牢记这一异常情况。
