![2
Surg Med Open Acc J Copyright © Chitra R
SMOAJ.MS.ID.000556. 3(2).2019
Discussion
A duplex (duplicated) system refers to a kidney with two
pelvicalyceal systems generally referred to as the upper or lower
poles. If the kidney has two ureters that empty separately into the
bladder (double ureters), it is considered a complete duplication.
In contrast, in a partial or incomplete duplication, a common single
ureter enters the bladder. A bifid system is a form of duplication
with two pelvicalyceal systems joining at the ureteropelvic junction
(bifid pelvis) or before emptying into the bladder (bifid ureters).
The ectopic ureter may be defined by the fact that the orifice
opening into the urinary bladder has a position different from
the normal trigone. However, in current practice, the term ectopic
ureter defines the situations in which the ureter is in the urethra or
outside the urinary tract [1].
Duplication of the ureters is the most common anomaly of the
urinary tract [2]. Ureteral duplication is one of the most common
renal congenital abnormalities with an incidence of 0.7-4% [3].
Incomplete duplication is three times more common than complete
duplication in about one of every 500 people. Duplications may be
discovered in childhood or, less frequently, in later life, or they may
be discovered at autopsy [4,5].
The ureters arise from the mesonephric ducts. The ureter of
the lower renal pole arises inferiorly and is incorporated into the
developing bladder first. It ascends during bladder growth and
inserts superiorly and laterally to the ureter of the upper renal
pole (Wiegert-Meyer rule). The ureter of the upper pole remains
with the mesonephric duct longer. Its insertion is located in the
bladder or wherever remnants or derivatives of the duct are found
[6]. Incomplete duplication is most often associated with uretero
ureteral reflux or ureteropelvic junction obstruction of the lower
pole of the kidney. Complete duplication is most often associated
with vesicoureteral reflux, ectopic ureterocele, or ectopic ureteral
insertion, all of which are more common in girls than in boys [7].
A case report of duplex collecting system of kidneys with
ectopic ureter opening into the posterior urethra was reported by
Snjezana Milicevic et al. [8]. Johnston reviewed clinical series of
73 children with complete or incomplete duplication and of nine
cases in which the abnormality was a post-mortem finding [9]. Both
studies of intravenous pyelograms and cadavers for double ureters
were done by Prakash et al and reported 1% complete duplication
of ureters and 2% incomplete duplication of ureters [10]. In pelvic
surgery, surgeons should be aware of duplication of ureters which
is one of the commonest anomalies of upper urinary tract.
References
1. Nepple KG, Cooper CS, Snyder HM (2010) Ureteral duplication, ectopy,
and ureterocoeles (2nd
edn) In: Gearhart J, Rink R, Mouriquand P(Eds.),
Pediatric Urology. Philadelphia pp. 337-352.
2. Nordmark B (1948) Double formations of the pelves of the kidneys
and the ureters: Embryology, occurrence and clinical significance. Acta
Radiol 30(4-5): 276-278.
3. Kawahara T, Ito H, Terao H, Kato Y, Ogawa T, et al. (2012) Ureteroscopy
assisted retrograde nephrostomy (UARN) for an incomplete double
ureter. Urol Res 40(6): 781-782.
4. Amitai M, Hertz M, Jonas P, Apter S, Heyman Z (1992) Ectopic ureterocele
in adults with a companies on of the anomaly in children. Urol Radiol 13:
181-186.
5. Cronan JJ, Amis ES, Zeman RK, Dorfman GS (1986) Obstruction of
the upper pole moiety in renal duplication in adults: CT evaluation.
Radiology 161(1): 17-21.
6. Mackie GG, Stephens FD (1975) Duplex kidneys: A correlation of renal
dysplasia with position of the ureteral orifice. J Urol 114(2): 274-280.
7. Fernbach SK, Feinstein KA, Spencer K, Lindstrom CA (1997) Ureteral
duplication and its complications. Radiographic 17(1): 109-127.
8. Milicevic S, Bijelic R, Krivokuca V, Jakovljevic B (2018) Duplex system
with ectopic ureter opens into the posterior urethra: Case Report. Med
Arch 72(2): 145-147.
9. Johnston JH (1961) Urinary tract duplication in childhood. Arch Dis
Child 36: 180.
10. Prakash, Rajini T, Venkatiah J, Bhardwaj AK, Singh DK, et al. (2011)
Double ureter and duplex system-A cadaver and radiological study.
Urology Journal 8(2): 145-148.
For possible submissions Click below:
Submit Article](https://image.slidesharecdn.com/smoaj-210209053446/85/Smoaj-000556-2-320.jpg)
Smoaj.000556
- 1. Duplex Collecting System of a Right Kidney With an Ectopic Ureter-A Case Report Shakthi Kumaran R and Chitra R* Professor of Anatomy, India Case Report In the routine educational dissection for the undergraduate students in the department of anatomy, Siddhartha medical college, Vijayawada in the academic years (2016-2017), in a male cadaver, on the right side, double ureters were observed. The ureter draining the lower pole opened in to the trigone of the urinary bladder from right side. The ureter draining the upper pole crossed the ureter of the lower pole posteriorly from medial to lateral side and opened into the prostatic urethra on the right side (Figure 1). There was a single ureter on the left kidney draining into the trigone of the urinary bladder. Figure 1: Duplex collecting system of a right kidney with an ectopic ureter. 1. Right kidney. 2. Left kidney. 3. Urinary bladder. 4. Prostatic urethra. 5. Upper pole ureter of right kidney (ectopic ureter). 6. Lower pole ureter of right kidney. 7. Left ureter. Crimson Publishers Wings to the Research Case Report *Corresponding author: Chitra R, Professor of Anatomy, India Submission: September 20, 2019 Published: October 15, 2019 Volume 3 - Issue 1 How to cite this article: Shakthi Kumaran R, Chitra R. Duplex Collecting System of a Right Kidney With an Ectopic Ureter-A Case Report. Surg Med Open Acc J.3(2). SMOAJ.000556.2019. DOI:10.31031/SMOAJ.2019.03.000556. Copyright@ Chitra R, This article is distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited. ISSN: 2578-0379 1 Surgical Medicine Open Access Journal Abstract Ureteral abnormalities represent a complex subset of urologic anomalies that manifest in many ways. Duplication of the ureters is a common anomaly and is frequently encountered by radiologists. Dupli- cation may be either complete or incomplete and is often accompanied by various complications. Here, we report a case of the complete duplicated ureters with an ectopic ureteral opening in to the prostatic urethra in a male cadaver on the right side during routine educational dissection in the academic years (2017-2018) in our department of anatomy at Siddhartha medical college, Vijayawada. Imaging tech- niques to visualize the ureters are excretory urography and voiding cystourethrography, as well as ultra- sound, computed tomography, and magnetic resonance imaging. Keywords: Duplicated ureters; Ectopic ureter; Excretory urography; Voiding cystourethrography; Pros- tatic urethra
- 2. 2 Surg Med Open Acc J Copyright © Chitra R SMOAJ.MS.ID.000556. 3(2).2019 Discussion A duplex (duplicated) system refers to a kidney with two pelvicalyceal systems generally referred to as the upper or lower poles. If the kidney has two ureters that empty separately into the bladder (double ureters), it is considered a complete duplication. In contrast, in a partial or incomplete duplication, a common single ureter enters the bladder. A bifid system is a form of duplication with two pelvicalyceal systems joining at the ureteropelvic junction (bifid pelvis) or before emptying into the bladder (bifid ureters). The ectopic ureter may be defined by the fact that the orifice opening into the urinary bladder has a position different from the normal trigone. However, in current practice, the term ectopic ureter defines the situations in which the ureter is in the urethra or outside the urinary tract [1]. Duplication of the ureters is the most common anomaly of the urinary tract [2]. Ureteral duplication is one of the most common renal congenital abnormalities with an incidence of 0.7-4% [3]. Incomplete duplication is three times more common than complete duplication in about one of every 500 people. Duplications may be discovered in childhood or, less frequently, in later life, or they may be discovered at autopsy [4,5]. The ureters arise from the mesonephric ducts. The ureter of the lower renal pole arises inferiorly and is incorporated into the developing bladder first. It ascends during bladder growth and inserts superiorly and laterally to the ureter of the upper renal pole (Wiegert-Meyer rule). The ureter of the upper pole remains with the mesonephric duct longer. Its insertion is located in the bladder or wherever remnants or derivatives of the duct are found [6]. Incomplete duplication is most often associated with uretero ureteral reflux or ureteropelvic junction obstruction of the lower pole of the kidney. Complete duplication is most often associated with vesicoureteral reflux, ectopic ureterocele, or ectopic ureteral insertion, all of which are more common in girls than in boys [7]. A case report of duplex collecting system of kidneys with ectopic ureter opening into the posterior urethra was reported by Snjezana Milicevic et al. [8]. Johnston reviewed clinical series of 73 children with complete or incomplete duplication and of nine cases in which the abnormality was a post-mortem finding [9]. Both studies of intravenous pyelograms and cadavers for double ureters were done by Prakash et al and reported 1% complete duplication of ureters and 2% incomplete duplication of ureters [10]. In pelvic surgery, surgeons should be aware of duplication of ureters which is one of the commonest anomalies of upper urinary tract. References 1. Nepple KG, Cooper CS, Snyder HM (2010) Ureteral duplication, ectopy, and ureterocoeles (2nd edn) In: Gearhart J, Rink R, Mouriquand P(Eds.), Pediatric Urology. Philadelphia pp. 337-352. 2. Nordmark B (1948) Double formations of the pelves of the kidneys and the ureters: Embryology, occurrence and clinical significance. Acta Radiol 30(4-5): 276-278. 3. Kawahara T, Ito H, Terao H, Kato Y, Ogawa T, et al. (2012) Ureteroscopy assisted retrograde nephrostomy (UARN) for an incomplete double ureter. Urol Res 40(6): 781-782. 4. Amitai M, Hertz M, Jonas P, Apter S, Heyman Z (1992) Ectopic ureterocele in adults with a companies on of the anomaly in children. Urol Radiol 13: 181-186. 5. Cronan JJ, Amis ES, Zeman RK, Dorfman GS (1986) Obstruction of the upper pole moiety in renal duplication in adults: CT evaluation. Radiology 161(1): 17-21. 6. Mackie GG, Stephens FD (1975) Duplex kidneys: A correlation of renal dysplasia with position of the ureteral orifice. J Urol 114(2): 274-280. 7. Fernbach SK, Feinstein KA, Spencer K, Lindstrom CA (1997) Ureteral duplication and its complications. Radiographic 17(1): 109-127. 8. Milicevic S, Bijelic R, Krivokuca V, Jakovljevic B (2018) Duplex system with ectopic ureter opens into the posterior urethra: Case Report. Med Arch 72(2): 145-147. 9. Johnston JH (1961) Urinary tract duplication in childhood. Arch Dis Child 36: 180. 10. Prakash, Rajini T, Venkatiah J, Bhardwaj AK, Singh DK, et al. (2011) Double ureter and duplex system-A cadaver and radiological study. Urology Journal 8(2): 145-148. For possible submissions Click below: Submit Article