Roberts Charlotte K, Ellison Jonathan S, Aboumarzouk Omar, Abd-Alazeez Mohamed, Keeley Francis X
The Bristol Urological Institute, Bristol, United Kingdom.
Can J Urol. 2018 Oct;25(5):9503-9508.
Renal duplication is a relatively common congenital abnormality of the urinary tract, but symptomatic duplex kidney is a rare presentation in adults. Traditionally, the treatment of choice for poorly functioning moiety has been heminephrectomy. There is extensive literature detailing the outcomes of minimally invasive upper pole heminephrectomy, but comparatively little published regarding lower pole resection, especially in adult patients. We present a series of 13 patients who underwent minimally invasive heminephrectomy for duplex kidney.
Over a 6 year period (2011-2017) 13 patients at a single center underwent laparoscopic heminephrectomy for symptomatic duplex kidney with a poorly functioning moiety. A retrospective review of case notes and imaging was undertaken.
Eight and 5 patients underwent upper and lower pole heminephrectomies, respectively. Laparoscopic transperitoneal approach was utilized in all cases. Median length of stay was 2 days (range 1 to 16 days). In the upper pole cohort, one patient had a postoperative infection requiring IV antibiotics. In the lower pole cohort by contrast, there were three major complications (60%). Conversion to complete nephrectomy was necessary in one case; one patient had urinary leakage requiring selective embolization and one patient required a second operation to resect remnant calyces. Furthermore, two patients (40%) developed late recurrence of symptoms.
Symptomatic duplex kidney is a rare presentation in adults. In our experience, heminephrectomy for non-functioning renal unit is safe and reproducible in experienced hands with no major complications and resolution of symptoms in the majority of patients. We have, however, observed a higher complication rate in those undergoing resection of a lower pole moiety. Alternative management such as uretero-ureterostomy should be considered in these cases.
重复肾是一种相对常见的先天性泌尿系统异常，但有症状的重复肾在成人中较为罕见。传统上，对于功能不良部分的治疗选择是半肾切除术。有大量文献详细描述了微创上极半肾切除术的结果，但关于下极切除术的发表文献相对较少，尤其是在成年患者中。我们报告了一系列13例接受重复肾微创半肾切除术的患者。
在6年期间（2011 - 2017年），单一中心的13例患者因有症状的重复肾且部分功能不良接受了腹腔镜半肾切除术。对病例记录和影像学资料进行了回顾性分析。
分别有8例和5例患者接受了上极和下极半肾切除术。所有病例均采用腹腔镜经腹入路。中位住院时间为2天（范围1至16天）。在上极组中，1例患者术后感染，需要静脉使用抗生素。相比之下，在下极组中，有3例主要并发症（60%）；1例患者需要转为全肾切除术；1例患者发生尿漏，需要选择性栓塞；1例患者需要二次手术切除残余肾盏。此外，2例患者（40%）出现症状晚期复发。
有症状的重复肾在成人中较为罕见。根据我们的经验，对于无功能肾单位的半肾切除术在经验丰富的医生手中是安全且可重复的，大多数患者无主要并发症且症状得到缓解。然而，我们观察到下极部分切除术的并发症发生率较高。在这些病例中应考虑替代治疗方法，如输尿管 - 输尿管吻合术。
