Diagnostic Ultrasound - Abdomen and Pelvis

Ureteral Duplication
Diagnoses: Urinary Tract
CLINICAL ISSUES
Presentation
• Most common signs/symptoms
○ Most often diagnosed on antenatal ultrasound or
incidentally
○ Usually asymptomatic
○ Urinary tract infection including pyelonephritis
○ Hematuria, abdominal/flank pain due to obstruction or
formation of calculi
○ Voiding dysfunction, urinary retention
○ Ectopic insertion
– Females: Incontinence due to insertion below bladder
sphincter
– Males: Prostatitis, epididymitis
• Other signs/symptoms
○ Transitional cell carcinoma of duplicated ureter occurs in
elderly population
Demographics
• Gender
○ More common in females
• Epidemiology
○ 1 per 125-250 persons
Natural History & Prognosis
• Longstanding obstruction, reflux and infection can lead to
secondary hypertension and renal insufficiency/failure
Treatment
• Lower grades of reflux: Medical treatment
• Higher grades of reflux, upper pole obstruction, ectopy,
poor renal function: Surgical treatment
8. Fernbach SK et al: Complete duplication of the ureter with ureteropelvic
junction obstruction of the lower pole of the kidney: imaging findings. AJR
Am J Roentgenol. 164(3):701-4, 1995
9. Husmann DA et al: Ureterocele associated with ureteral duplication and a
nonfunctioning upper pole segment: management by partial
nephroureterectomy alone. J Urol. 154(2 Pt 2):723-6, 1995
10. Share JC et al: The unsuspected double collecting system on imaging studies
and at cystoscopy. AJR Am J Roentgenol. 155(3):561-4, 1990
11. Winters WD et al: Importance of prenatal detection of hydronephrosis of
the upper pole. AJR Am J Roentgenol. 155(1):125-9, 1990
12. Share JC et al: Ectopic ureterocele without ureteral and calyceal dilatation
(ureterocele disproportion): findings on urography and sonography. AJR Am
J Roentgenol. 152(3):567-71, 1989
13. Ahmed S et al: Vesicoureteral reflux in complete ureteral duplication:
surgical options. J Urol. 140(5 Pt 2):1092-4, 1988
14. Bisset GS 3rd et al: The duplex collecting system in girls with urinary tract
infection: prevalence and significance. AJR Am J Roentgenol. 148(3):497-
500, 1987
15. Mesrobian HG: Ureteropelvic junction obstruction of the upper pole moiety
in complete ureteral duplication. J Urol. 136(2):452-3, 1986
16. Nussbaum AR et al: Ectopic ureter and ureterocele: their varied sonographic
manifestations. Radiology. 159(1):227-35, 1986
17. Amis ES Jr et al: Lower moiety hydronephrosis in duplicated kidneys.
Urology. 26(1):82-8, 1985
18. Lavallee G et al: Obstructed duplex kidney in an adult: ultrasonic evaluation.
J Clin Ultrasound. 13(4):281-3, 1985
19. Gartell PC et al: Renal dysplasia and duplex kidneys. Eur Urol. 9(2):65-8, 1983
20. Inamoto K et al: Duplication of the renal pelvis and ureter: associated
anomalies and pathological conditions. Radiat Med. 1(1):55-64, 1983
21. Gates GF: Ultrasonography of the urinary tract in children. Urol Clin North
Am. 7(2):215-22, 1980
22. Morgan CL et al: Ultrasonic diagnosis of obstructed renal duplication and
ureterocele. South Med J. 73(8):1016-9, 1980
23. Rose JS et al: Ultrasound diagnosis of ectopic ureterocele. Pediatr Radiol.
8(1):17-20, 1979
24. Mascatello VJ et al: Ultrasonic evaluation of the obstructed duplex kidney.
AJR Am J Roentgenol. 129(1):113-20, 1977
DIAGNOSTIC CHECKLIST
Consider
• Young females with recurrent urinary tract infections
• Young females with continuous dribbling urinary
incontinence
Image Interpretation Pearls
• 2 distinct renal pelves or ureters
• US, IVP, or CT/MR urography are imaging modalities of
choice
• VCUG to exclude reflux
SELECTED REFERENCES
1. Lipson JA et al: Subtle renal duplication as an unrecognized cause of
childhood incontinence: diagnosis by magnetic resonance urography. J
Pediatr Urol. 4(5):398-400, 2008
2. Wah TM et al: Lower moiety pelvic-ureteric junction obstruction (PUJO) of
the duplex kidney presenting with pyonephrosis in adults. Br J Radiol.
76(912):909-12, 2003
3. Callahan MJ: The drooping lily sign. Radiology. 219(1):226-8, 2001
4. Zissin R et al: Renal duplication with associated complications in adults: CT
findings in 26 cases. Clin Radiol. 56(1):58-63, 2001
5. Fernbach SK et al: Ureteral duplication and its complications. Radiographics.
17(1):109-27, 1997
6. Ulchaker J et al: The spectrum of ureteropelvic junction obstructions
occurring in duplicated collecting systems. J Pediatr Surg. 31(9):1221-4, 1996
7. Bellah RD et al: Ureterocele eversion with vesicoureteral reflux in duplex
kidneys: findings at voiding cystourethrography. AJR Am J Roentgenol.
165(2):409-13, 1995
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