Treatment of Duplex Renal System in India
Introduction
The
duplex renal system involves the presence of two ureters in a single kidney.
The renal duplex system may be complete or incomplete. Many patients do not
have symptoms. Most of these cases are diagnosed on antenatal scan or when they
present with urinary tract infections. It is a congenital condition and may
require various procedures to salvage the renal functions.
Duplex Renal System
The duplex renal system is also known as a duplicated
collecting system or renal duplex. Urine formation takes place in the kidney.
From kidneys, the urine flows to the urinary bladder through small tube-like
structures. These tube-like structures are known as ureters. In normal case,
one ureter from each kidney drains the urine to the bladder. However, in duplex
system kidney gets duplicated forming two system with two ureters each. One
ureter drains the urine from the upper part of the kidney while another drains
urine from the lower part.
Types Of Duplex Renal System
The duplex renal system
may be of the following two types:
Incomplete duplex renal system: In the incomplete duplex renal system, two ureters drain
the urine from a kidney. However, the ureters join somewhere between the kidney
and the bladder and enter the bladder as a single ureter.
Complete duplex renal system: In the complete duplex urinary system, two ureters drain
urine from a kidney and enters the bladder at two different points.
Prevalence
of Duplex Renal System
Approximately 0.7% of healthy people may have a duplex renal
system. The incidence of this condition increases to 2-4% in patients who
already have urinary tract issues. The prevalence of incomplete duplex system
is three times more in comparison to the complete duplex system. The condition
is more common in females.
Symptoms of Duplex Renal System
Till the urine from the duplex ureters drains
normally into the bladder and is not refluxing, the person may not experience
any symptoms. Sometimes the ectopic ureter may open outside the bladder like urethra
or vaginal in females causing urinary incontinent. Some of the common
presentation and symptoms are:
Recurrent urinary tract infection
Urinary incontinence
Hydronephrosis
Vesicoureteral reflux
Causes of Duplex Renal System
The condition of the renal duplex system is
congenital i.e., it is present by birth. It may be due to abnormal development
of the urinary tract system. What causes this in the womb remains
unknown.
Diagnosis of Duplex Renal System
Your doctor may diagnose the condition
through the following methods:
Physical examination: The doctor may
perform the physical examination and ask you various questions about your
symptoms. The doctor may ask you about an alteration in urination, medical
history of urinary tract infection, and if you have a family history of a renal
duplex system.
Ultrasound: Ultrasound may help in
determining the presence of the duplex urinary system and associated
hydronephrosis.
MRI Urogram or CT Urogram: The
doctor recommends scanning to determine the presence of duplex ureters through
3-D imaging.
VCUG (voiding cysto-urethrogram) : To know
the presence of vesico-ureteric reflux which is commonly associated with duplex
system.
Treatment Of Duplex Renal System
Most people do not require treatment for the
duplex renal system.
Surgery is recommended in a symptomatic child
or in case of deteriorating renal function.
In case the patients require treatment, the
doctor may recommend the following procedures:
Ureteral reimplantation: In this
procedure, obstructed or refluxing ureter is disconnected and again reimplanted
in bladder.
Ureteroureterostomy: The obstructed or
refluxing ureter is joined to normal ureter.
Hemi-Nephrectomy: The doctor does not
commonly use this procedure. The doctor removes the part of kidney, which is
not working properly. This helps in avoiding symptoms such as urinary tract
infection and urinary incontinence.
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