title: Bilateral obstruction of bilaterally duplicated collecting systems requiring upper and lower moiety drainage.
abstract: A 60-year-old woman with a history of breast cancer presented with bilateral obstruction of bilaterally duplicated renal collecting systems secondary to extrinsic compression from metastatic pelvic lymphadenopathy. Bilateral JJ ureteric stents were inserted, resulting in some improvement of renal function but a failure to normalise completely. Repeat computed tomography demonstrated bilateral duplex collecting systems with persisting obstruction of the undrained moieties. Selective puncture was performed to decompress the obstructed renal moieties for bilateral nephrostomy catheter insertion. This allowed renal function to improve sufficiently for the patient to be discharged and commence chemotherapy. This is the first reported case of bilaterally obstructed partially duplicated collecting systems and it illustrates the importance of recognising anatomical variants to tailor treatment appropriately. It also highlights the important relationship between urology and interventional radiology in the management of such complex patients.
authors.affiliation: East and North Hertfordshire NHS Trust , UK.
authors.forename: J O
authors.initials: JO
authors.lastname: Lynch
authors.affiliation: East and North Hertfordshire NHS Trust , UK.
authors.forename: A
authors.initials: A
authors.lastname: Cox
authors.affiliation: East and North Hertfordshire NHS Trust , UK.
authors.forename: B
authors.initials: B
authors.lastname: Rawal
authors.affiliation: Great Ormond Street Hospital for Children NHS Foundation Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Shelmerdine
authors.affiliation: East and North Hertfordshire NHS Trust , UK.
authors.forename: N
authors.initials: N
authors.lastname: Vasdev
authors.affiliation: East and North Hertfordshire NHS Trust , UK.
authors.forename: A
authors.initials: A
authors.lastname: Patel
mesh_terms: D001943:Breast Neoplasms / Q000150:complications; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007684:Kidney Tubules / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D049268:Positron-Emission Tomography; D015607:Stents; D014057:Tomography, X-Ray Computed; D014517:Ureteral Obstruction
keywords: Abnormalities; Collecting systems; Interventional radiography; Kidney tubules; Urology