Diagnosis And Treatment Of Duplex Kidney With Abnormal Ureterovesical Junction

BackgroundDuplex kidney is a common congenital abnormaity of urinary system,carrying an incidence of approximately 0.8%,the incidence is higher in women,male/female ratio is 1/2,most of the duplex kidney is unilateral,6 times that of bilateral repeated kidney,the incidence of the left side is 1.5-2 times that of the right side,incomplete duplex kidney is 4 times that of complete duplex kidney.Moreover,the duplication of the kidney is often associated with ectopic ureter orifice,ureterocele,vesicoureteral reflux(VUR),and ureterovesical junction obstruction.In recent years,with the continuous development of imaging,most children can be found when their mother carries out color ultrasound examination.The girls who have duplex kidney with ectopic ureter orifice mostly have go to see a doctor because of the perineum continued drops of urine.the most children of the duplex kidney with ureterocele,VUR and ureterovesical junction obstruction have no clinical symptoms,often accidentally discovered due to a febrile urinary tract infection,waist,or abdominal pain,or haematuria.Because of the complexity of the duplex kidney and its combination of abnormal deformity,the diagnosis often require a series of imaging examination,mainly have urinary colour ultrasound,computed tomography urograph(CTU),nuclear magnetic resonance(NMR),magnetic resonance urograph(MRU),voiding cystourethrogram(VCUG),intravenous pyelography(IVP),radionuclide examination,etc.The treatment methods include conservative treatment and surgical treatment.Most asymptomatic children with no obvious abnormality in imaging examination can be treated conservatively and reviewed regularly.The main surgical methods include endoscopic ureterocele transurethral incision(TUI),Ureteroureterostomy(UU),the heminephrectomy with partial ureterectomy,ureteral reimplantation and upper pole ureteral clipping.In recent years,minimally invasive techniques such as laparoscopy and Da Vinci robot have been gradually applied to the treatment of duplex kidney,but they are still not widespread,and open surgery is still a good choice.In this study,50 children with duplex kidney received surgical treatment in the pediatric urology department of the first affiliated hospital of zhengzhou university were collected,and their clinical data were analyzed and the diagnosis,treatment and prognosis of this disease were discussed in combination with relevant domestic and foreign literatures.MethodsThe number of cases included in this study was 50.All of them were admitted to the department of pediatric urology,the first affiliated hospital of zhengzhou university,zhengzhou city,henan province from February 2017 to December 2019,and all of them were diagnosed with renal duplication and abnormal ureterovesical junction and underwent surgical treatment.The mean age was 17.16±12.36 months,including 17 males and 33 females.There were 33 cases on the left,15 cases on the right,and 2 cases on both sides.There were 46 cases of complete type and 4 cases of incomplete type.The diacovery reasons were as follows:pregnancy examination in 17 cases,physical examination in 16 cases,recurrent urinary tract infection in 9 cases,abnormal urination in 6 cases,and abdominal pain in 2 cases.There were 14 cases of ectopic ureter,12 cases of ureterocele,6cases of UVJO,10 cases of VUR,5 cases of ureterocele and VUR,2 cases of ectopic ureterocele,1 case of ectopic ureteral and VUR.In this study,50 children received color ultrasound,50 CTU,46 VCUG and 30 renal dynamic examination.Ureteral reimplantation and the heminephrectomy with partial ureterectomy were performed according to the patient's condition.After the consent of the family,the patients were randomly divided into open surgery group and laparoscopic surgery group,respectively.All the surgeries were performed under general anesthesia,and all the laparoscopic operations were performed via the intraperitoneal approach.The children were routinely followed up with color ultrasound and routine urine examination in the outpatient department 1 month,3 months,6 months and 1 year after the surgery.ResultsColor ultrasonography was performed on all 50 children with duplex kidney,and 45(80%)of them were found to have duplex kidney and the diagnosis accordance of CTU were 100%.There were 19 cases with ureteroceles all of which were from the upper ureter of the duplex kidney except one,17 cases with ectopic ureter,all of which were from the upper ureter of the duplex kidney,16 cases with VUR(1 case with both upper and lower ureteral reflux,1 case with upper ureteral reflux),and 14 cases with lower ureteral ureter.Open ureteral reimplantation 17 cases(group A),gas-bladder laparoscopic ureteral reimplantation(group B)10 cases,open heminephrectomy with partial ureterectomy group(C)in 16 cases,laparoscopic heminephrectomy with partial ureterectomy(group D)6 cases,Da Vinci robots laparoscopic heminephrectomy with partial ureterectomy group(E)1 case,There were 1 case of urinary tract infections postoperative in group A and group B respectively,after oral antibiotics to cure;In group C,1 case of ureteral stump infection was reoperated.The remaining children had no postoperative complications and clinical symptoms.Postoperative reexamination found that ureterocele,hydronephrosis and ureteral dilatation were significantly decreased compared with preoperative status.Conclusions1.Color ultrasound,CTU,dynamic renal imaging,VCUG complement eachother,and they can provide evidence for the diagnosis and treatment of duplex kidney with abnormal ureterovesical junction.2.Among the duplex kidney with abnormal ureterovesical junction.,the main complications of upper kidney were ureterocele and ectopic ureter orifice,while the main complications of lower kidney were VUR.3.Ureteral reimplantation and heminephrectomy with partial ureterectomy are the main surgical methods for the duplex kidney with abnormal ureterovesical junction,and both open surgery and laparoscopic surgery can be effectively used for their treatment.