雙套腎-病歷呈現、併發症及治療
趙浩堅1,、黃馨慧,2、陳順郎1,3、高育琳1,3、陳文榮,1、謝佐宜,1、王紹全,1
1中山醫學大學附設醫院泌尿科;
2中山醫學大學附設醫院醫學影像部
3台中中山醫學大學醫學院
Duplex Collecting Systems:
Presentation, Morbidity, and Treatment
Hao-Chien Chao1, Hsin-Hui Huang2, Sun-Lang Chen1, 3, Yu-Lin Kao1, 3, Wen-Jung Chen1, Zuou-Yi Shieh1, Shao-Chuan Wang1
1Division of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
2Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
3Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
Purpose:
Duplex collecting systems is the most common congenital anomaly, with an incidence of 0.8~1% during urinary tract development. They are usually asymptomatic and diagnosed incidentally by radiological survey for other reasons. Duplex collecting systems can be divided into complete and incomplete type and may associate with other anomalies. However, there is minimal literature on the review of this entity, its associated anomalies and complications. The purpose of this study is to review the presentations, characteristics, morbidities and treatment modalities in patients with duplex collecting system.
Materials and Methods:
We retrospectively evaluate the database of patients with duplex collecting systems both from chart records and radiological image studies with the term “duplication” or “duplex” between January, 2010 and September, 2015.
Results:
Two hundred and three patients were identified with age range from 1 month to 90 years (median: 53 years). Female accounted for 54.6% and 45.4% were male. More than half were incidental finding (55.6%) with the most common investigational tool as abdominal/pelvic computed tomography (CT: 43.4%, intravenous pyelogram: 36.5%, sono: 10.8%, magnetic resonance: 7.9%, retrograde pyelogram: 0.5%, cystoscopy: 0.5%, ureteroscopy: 0.4%). Patients with clinical manifestations included urinary tract infection, hematuria, flank pain, and incontinence. Most duplex ureters were incomplete (73.8%) and the conjoined level were left upper third: 45.4%; right upper third: 26.7%; left middle third: 12%; right middle third: 8.7%; left lower third: 4.6%; right lower third: 2.6% in orders. The most common morbidity was urolithiasis (29.6%) and ureterorenoscopic lithotripsy was applied for most of the cases. Eight of 24 patients with complete duplication had associated anomalies (ectopic ureteral orifice, ureterocele, hydronephrosis, UPJO).
Conclusion:
Duplex collecting systems are common but clinically insignificant. In this study, complete duplication showed higher incidence of ectopic ureter and surgical intervention was needed. Physicians should keep such developmental abnormalies in mind and proceed to prompt investigation and management.