Complete ureteral duplication !

Here is a case of 

47 yr male, c/o right flank pain one month back. H/o pyuria +. No history of UTI, childhood UTI. No medical comorbidity. On evaluation Usg s/o duplicated ureter right side with hydronephrotic upper moiety. CT urogram Images attached. 
1. What should be done next? Functional study vs upfront surgery.
2. What are the surgical options in case of a nonfunctional upper moiety with ectopic insertion in prostatic urethra? 
(2.a. Is the term "heminephrectomy" used or partial nephrectomy? ) 
(2.b. Shall it be managed by Heminephrectomy with ureterectomy or simply heminephrectomy ?)
(2.c. How to deal with the dilated ectopic ureter? Completely excise it or just remove the upper segment ?
(2.d. How shall the distal dilated ureteric stump be dealt with?  leave the stump open or closed ?)

3. If the DTPA study shows a functional upper moiety, what shall be done to preserve the function of upper moiety and render the patient free from the risk of recurrent UTI?

(3.a. Can ureteric reimplantation be considered ? If no, why ?)
(3.b. If ureteroureterostomy or ureteropyelostomy is planned, how shall the ectopic ureter distal stump be dealt with?)

4. Why has this adult male with a congenital anomaly manifested so late?

Complete ureteral duplication !Complete ureteral duplication !Complete ureteral duplication !Complete ureteral duplication !Complete ureteral duplication !Complete ureteral duplication !Complete ureteral duplication !


  • Uday Sankar Chatterjee
    Uday Sankar Chatterjee
    28 Jul 2020 05:47:34 PM

    My Opinion:

    1. Functional study.
    2. Hemispherectomy
            2d. Leave the stump open.
    3b. Pyelopyelostomy if possible/uretero-pyelostomy. Leave distal ureter open.

    4. Some congenital anomalies like Duplex system/RCU may not be symptomatic at all.

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    28 Jul 2020 09:13:27 PM

    Sir, kindly upload more ct cuts prefer ably urogram...can't make in this these cuts whether duplicate system or not???

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