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Bilateral Pelvicalyceal Duplication with Contralateral Drainage
Images in Clinical Urology Bilateral Pelvicalyceal Duplication with Contralateral Drainage Islam A. Ghoneim and Amr F. Fergany We report on a peculiar congenital duplication anomaly of the kidney and collecting system. A bifid left renal pelvis receives the ureter draining the lower moiety of a fully duplicated right system. To our knowledge, such an anomaly has not been previously described. UROLOGY 76: 849 – 850, 2010. © 2010 Elsevier Inc.
Figure 1. Abdominal computed tomography scan shows a normal upper moiety right ureter, and another ureter crossing the midline anterior to the great vessels.
Figure 2. Right retrograde pyelography.
A
28-year-oldmale presented with bilateral mild flank pain, more pronounced on the left side. Renal ultrasound showed a smaller hydronephrotic left kidney and a duplicated right kidney. Computed tomography scan confirmed these findings, and showed a ureter crossing the midline anterior to the great vessels (Fig. 1). Cystoscopy showed single normally placed ureteric orifices. Right retrograde pyelography showed the right ureter draining a normal upper moiety only (Fig. 2); whereas left retrograde pyelography showed a duplicated renal pelvis joined by the ureter from the right lower moiety crossing the midline (Fig. 3). Diuretic renography revealed renal function of 27% on the left and 73% on the right with no significant obstruc-
From the Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Reprint requests: Amr F. Fergany, M.D., Ph.D., Glickman Urological and Kidney Institute; Cleveland Clinic, 9500 Euclid Ave, Cleveland, Ohio 44195. E-mail: [email protected] Submitted: May 19, 2009, accepted (with revisions): September 24, 2009
© 2010 Elsevier Inc. All Rights Reserved
Figure 3. Left right retrograde pyelography indicating left bifid renal pelvis, and right lower moiety ureter crosses to join left ureter at L4/5.
tion on either side. With no firm indication for intervention, follow-up tests in 6 months were suggested and agreed upon by the patient. 0090-4295/10/$34.00 doi:10.1016/j.urology.2009.09.059
849
Approximately 10% of the normal renal pelves are bifid,1 and the incidence of ureteral duplication in autopsy series is approximately 1 in 125 patients. Duplication anomalies occur 2 times more frequently in girls than in boys and unilaterally 6 times more commonly than bilaterally.2 With mild symptoms and no evidence of obstruction, our patient elected a conservative approach. To our knowledge, such a duplication anomaly
850
with contralateral drainage has not been described previously. References 1. Bauer SB. Anomalies of the upper urinary tract. In Novick AC, Wein A, Kavoussi L, et al (eds). Campbell-Walsh Urology. Philadelphia, PA: WB Saunders; 2007:3303. 2. Decter RM. Renal duplication and fusion anomalies. Pediatr Clin North Am. 1997;44:1323-1341.
UROLOGY 76 (4), 2010
Figure 1. Abdominal computed tomography scan shows a normal upper moiety right ureter, and another ureter crossing the midline anterior to the great vessels.
Figure 2. Right retrograde pyelography.
A
28-year-oldmale presented with bilateral mild flank pain, more pronounced on the left side. Renal ultrasound showed a smaller hydronephrotic left kidney and a duplicated right kidney. Computed tomography scan confirmed these findings, and showed a ureter crossing the midline anterior to the great vessels (Fig. 1). Cystoscopy showed single normally placed ureteric orifices. Right retrograde pyelography showed the right ureter draining a normal upper moiety only (Fig. 2); whereas left retrograde pyelography showed a duplicated renal pelvis joined by the ureter from the right lower moiety crossing the midline (Fig. 3). Diuretic renography revealed renal function of 27% on the left and 73% on the right with no significant obstruc-
From the Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Reprint requests: Amr F. Fergany, M.D., Ph.D., Glickman Urological and Kidney Institute; Cleveland Clinic, 9500 Euclid Ave, Cleveland, Ohio 44195. E-mail: [email protected] Submitted: May 19, 2009, accepted (with revisions): September 24, 2009
© 2010 Elsevier Inc. All Rights Reserved
Figure 3. Left right retrograde pyelography indicating left bifid renal pelvis, and right lower moiety ureter crosses to join left ureter at L4/5.
tion on either side. With no firm indication for intervention, follow-up tests in 6 months were suggested and agreed upon by the patient. 0090-4295/10/$34.00 doi:10.1016/j.urology.2009.09.059
849
Approximately 10% of the normal renal pelves are bifid,1 and the incidence of ureteral duplication in autopsy series is approximately 1 in 125 patients. Duplication anomalies occur 2 times more frequently in girls than in boys and unilaterally 6 times more commonly than bilaterally.2 With mild symptoms and no evidence of obstruction, our patient elected a conservative approach. To our knowledge, such a duplication anomaly
850
with contralateral drainage has not been described previously. References 1. Bauer SB. Anomalies of the upper urinary tract. In Novick AC, Wein A, Kavoussi L, et al (eds). Campbell-Walsh Urology. Philadelphia, PA: WB Saunders; 2007:3303. 2. Decter RM. Renal duplication and fusion anomalies. Pediatr Clin North Am. 1997;44:1323-1341.
UROLOGY 76 (4), 2010