title: Presentation, Management and Long-Term Outcome of Ureteropelvic Junction Obstruction in Duplex Kidneys.
abstract: OBJECTIVE
  Ureteropelvic junction obstruction in association with a duplex collecting system is a rare but challenging upper urinary tract pathology. We report our 21-year experience with this anomaly in terms of presentation, diagnostic evaluation and management.
  
  
  METHODS
  We retrospectively identified all patients with ureteropelvic junction obstruction in a duplex collecting system between 1991 and 2012. We reviewed each case for presenting symptoms, anatomy and management. Median followup was 10.8 years (range 2 to 22).
  
  
  RESULTS
  Ureteropelvic junction obstruction in duplex kidneys was diagnosed in 21 patients. Ten patients presented with clinical symptoms such as flank pain and urinary tract infection but 11 were asymptomatic. Six patients were diagnosed by prenatal ultrasound. The lower pole and the upper pole were affected in 22 and 3 renal units, respectively. Bilateral ureteropelvic junction obstruction was found in 4 cases. Duplication was complete in 5 patients, incomplete in 11 and undetermined in 5. Surgery was performed in 14 patients, including pyelopyelostomy or ureteropyelostomy in 7, dismembered pyeloplasty in 6 and heminephrectomy in 1. Reintervention was required in 1 case. Conservative treatment was adopted in 7 patients with clinically insignificant obstruction and unimpaired renal function. In all of these patients upper urinary tract dilatation gradually improved during 3 years.
  
  
  CONCLUSIONS
  Ureteropelvic junction obstruction in a duplex kidney is a rare but challenging anomaly that requires careful evaluation. Treatment should be individualized according to clinical presentation (symptomatic/asymptomatic), anatomy (lower/upper pole), duplication type (complete/incomplete) and obstruction with time (severity/development) on dynamic renogram.
authors: Division of Pediatric Urology, Department of Urology, Mainz University Medical Center, Mainz, Germany. Electronic address: peter.rubenwolf@unimedizin-mainz.de.
authors: Peter
authors: P
authors: Rubenwolf
authors: Division of Pediatric Urology, Department of Urology, Mainz University Medical Center, Mainz, Germany.
authors: Christopher
authors: C
authors: Ziesel
authors: Division of Pediatric Nephrology, Department of Pediatrics, Mainz University Medical Center, Mainz, Germany.
authors: Rolf
authors: R
authors: Beetz
authors: Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed M
authors: MM
authors: Kamal
authors: Department of Urology, Mainz University Medical Center, Mainz, Germany.
authors: Joachim W
authors: JW
authors: Thüroff
authors: Division of Pediatric Urology, Department of Urology, Mainz University Medical Center, Mainz, Germany.
authors: Raimund
authors: R
authors: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities*; D007674:Kidney Diseases / Q000150:complications / Q000151:congenital* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult
keywords: congenital abnormalities; diagnosis; kidney; outcome and process assessment (health care); ureteral obstruction