Management of Upper Moiety in Complete Duplex System.
- Author:
Hyun Tae KIM
1
;
Eun Sang YOO
;
Sung Kwang CHUNG
Author Information
1. Department of Urology, College of Medicine, Kyungpook National University, Daegu, Korea.
- Publication Type:Original Article
- Keywords:
Gene duplication;
Ureter;
Ureterocele;
DMSA
- MeSH:
Follow-Up Studies;
Gene Duplication;
Humans;
Nephrectomy;
Retrospective Studies;
Succimer;
Ultrasonography;
Ureter;
Ureterocele;
Urinary Tract Infections;
Urography;
Vesico-Ureteral Reflux
- From:Korean Journal of Urology
2005;46(1):7-13
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Our experience of upper moiety in the complete duplex system was retrospectively analyzed to determine its optimum management. MATERIALS AND METHODS: Between 1988 and 2003, 27 patients were treated with the complete duplex system. Fifteen patients had ureterocele (9 intravesical, 6 ectopic) and the other 12 had an ectopic ureter. In all cases, excretory urography, ultrasonography, voiding cysto-urethrogram (VCUG) and dimercaptosuccinic acid (DMSA) renal scan were performed. The initial treatment was performed using salvage (transurethral incision or ureteropyelostomy) or non-salvage procedures (upper pole nephrectomy or nephrectomy). The median follow-up was 30 (13-48) months. RESULTS: The 27 patients were divided into three groups based on the function of the upper moiety from the DMSA renal scan - <10%; 13 patients (group A), 10-15%; 3 patients (group B), > or=15%; 11 patients (group C). In group A, upper pole nephrectomy was performed in 9 patients, a total reconstruction in 3 and a nephrectomy in 1. In group B, an upper pole nephrectomy was initially performed, with an ureteropyelostomy and transurethral incision (TUI). In group C, all patients received a transurethral incision as the initial treatment. The ipsilateral renal function was well conserved in the cases of upper pole nephrectomy, with no complications. Patients initially receiving salvage procedures showed a significant improvement and conservation of the ipsilateral renal function, but 4 patients required additional operative management due to moderate to severe vesicoureteral reflux (VUR), recurrent urinary tract infection and decreased renal function of the upper moiety. CONCLUSIONS: Salvage procedures are a preferable adequate therapeutic modality for the complete duplex system with a well conserved renal function.
