Management of Upper Moiety in Complete Duplex System

Kim, Hyun Tae; Yoo, Eun Sang; Chung, Sung Kwang

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.