What is ureteral duplication?

Ureteral duplication, also called the duplex collecting system, is a relatively common anatomical abnormality in which a patient has two ureters instead of one. A ureter is the tube that connects a kidney to the bladder. Normally, each kidney has a ureter to drain urine from that organ to the bladder, but sometimes both kidneys are affected, so both organs have an extra ureter.

Patients who have a ureterocele often have ureteral duplication. A ureterocele refers to the enlargement of the part of the ureter that is closest to the bladder. The opening of the ureter to the bladder is also abnormally narrowed. Ureteroceles can interfere with the proper flow of urine and can cause urine to back up into the ureter.

It is possible that a ureteral duplication is associated with genetics; However, the exact cause is unknown. Women tend to be at higher risk for this medical condition than men, and women will usually have both kidneys affected as well. The condition is usually diagnosed in utero with prenatal ultrasound. This is an imaging test used to diagnose potential problems before birth. After birth, a ureteral duplication may be suspected if the child frequently suffers from urinary tract infections.

Children who also have urinary tract infections will likely be treated with antibiotics. In severe cases, they may also be given fluids intravenously. A urologist will evaluate the patient's specific condition and her medical history to determine a treatment plan. When surgery is necessary, it is usually delayed until the patient is at least six to 12 months old. Babies have a very small bladder, which can complicate surgery and increase the risk of complications.

Patients with ureteral duplication who do not appear to suffer from the adverse effects of the condition may not require treatment. If the ureterocele severely constricts the ureter and causes urine to reflux, the urine may need to be drained surgically. In some cases, the urologist may recommend removal of the ureter with the ureterocele, leaving the duplicate ureter functioning.

A variety of other surgeries can be used to treat a ureteral duplication, including a cutaneous ureterostomy, where the surgeon will separate the ureters at the point where they connect to the bladder. They protrude through an opening in the abdomen, and urine collects in external bags. Later, the patient will undergo a second surgery to replace the ureters, and in some cases, a partial nephrectomy may also be needed to remove a portion of a damaged kidney.

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