Duplex renal systemComplete/Partial Duplex Renal System, .pptx

Duplex Renal System:


A congenital anomaly where the kidney has two separate collecting systems, each with its own:


- Renal pelvis
- Calyces
- Ureter (complete duplication) or merged ureter (partial duplication)


Types:


- Complete Duplication
- Partial Duplication
- Inverted Duplication
Symptoms:


- Asymptomatic
- UTIs
- Hematuria
- Flank pain
- Hydronephrosis


Treatment:


- Observation
- Antibiotics
- Surgery (obstruction, stones, or reflux)
- Endoscopic procedures

1. DUPLEX RENAL SYSTEM DR.JAWAD SAIFULLAH PGR UROLOGY AND RENAL TRANSPLANTATION ALLIED HOSPITAL , FAISALABAD

2. learning objectives: 2. Identify its anatomical features. 1. Define duplex renal system. 3. Recognize potential complications. 4. Learn how to diagnose and manage related disorders.

3. what is a DUPLEX RENAL SYSTEM: A duplex renal system occurs when there is a duplication of the ureter, resulting in two ureters draining a single kidney. The exact prevalence of this anomaly is difficult to ascertain because most patients are asymptomatic, and the abnormality is frequently detected incidentally.  Prevalence 1-2%.

4. Embryology The ureteric bud grows towards the metanephric blastema (nephrogenic cord), which later develops into the nephrons of the kidney. The collecting system of the kidney develops from the ureteric bud, a small outgrowth from the mesonephric duct (Wolffian duct) . The interaction between the ureteric bud and the metanephric blastema is crucial for the formation of the collecting system.

5. Incomplete duplex ureter (Bifid ureter): This anomaly develops when a single ureteral bud branches before it reaches the metanephric blastema. 01 02 • The duplicated ureters unite at a variable distance from the kidney, and only one ureteral orifice is present on the affected side.

6. Complete duplex ureter: In the case of complete duplication of the ureter, a developmental abnormality occurs where two ureteric buds arise from the mesonephric duct instead of the normal single bud. This leads to the formation of two ureters originating from a single kidney rather than the typical single ureter. 01 02

7. Complications: INCOMPLETE DUPLEX URETER: Ureteroureteral reflux, also known as yo-yo, saddle, or seesaw reflux, is a common phenomenon This is commonly associated with vesicoureteral reflux as a result of a lack of sufficient submucosal tunnel that leads to pyelonephritis, scarring and a so-called “drooping lily” appearance on IVPs

8. COMPLETE DUPLICATION: Ureters that arise from a position either lower or higher than the normal position are associated with ectopic insertions, renal dysplasia, and related complications Common complications of complete duplication are vesicoureteral reflux, ectopic ureterocele, ectopic ureteral insertion, ureteropelvic junction obstruction of the lower pole.

9. Most common of ectopic ureteric orifice: Male : Orifice in prostatic urethra and in proximal to external urinary sphincter. Female: Orifice of upper moiety ureter is in urethra distal to urinary sphincter.

10. Investigations Ultrasound is often the first-line imaging modality used to diagnose a duplex renal system. Anatomical Assessment Complications Detection Monitoring Guidance for Procedures Sonography:

11. Intravenous urography: Evaluation of the function of each kidney Identifying any structural abnormalities Assessing the drainage of urine

12. DTPA(Diethylenetriaminepentaacetic acid) CT Urography

13. Management: With complications Without complications No intervention required What are the symptoms/complications?

14. Complications and treatments: 01 Urolithiasis : URS , RIRS , PCNL, ESWL ,pyelolithotomy, ureterolithotomy 02 Reflux : Re-implantation of ureter. 03 Obstruction : Pyeloplasty 04 Ectopic ureter : Re-implantation 05 Nonfunctioning kidney : Nephrectomy, partial nephrectomy

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