Duplicated ureter - Wikipedia, the free encyclopedia 19/04/15 12:13

Duplicated ureter
From Wikipedia, the free encyclopedia

Duplicated ureter or Duplex Collecting System is a congenital

condition in which the ureteric bud, the embryological origin of the
ureter, splits (or arises twice), resulting in two ureters draining a single
kidney. It is the most common renal abnormality, occurring in
approximately 1% of the population.[1][2] The additional ureter may
result in a ureterocele, or an ectopic ureter.

Contents
1 Pathophysiology
2 Classification
3 Prevalence
4 Clinical Presentation
5 References
6 See also

Duplicated ureter

Pathophysiology
Ureteral development begins in the human fetus around the 4th week of embryonic development. A ureteric
bud, arising from the mesonephric (or Wolffian) duct, gives rise to the ureter, as well as other parts of the
collective system. In the case of a duplicated ureter, the ureteric bud either splits or arises twice. In most cases,
the kidney is divided into two parts, an upper and lower lobe, with some overlap due to intermingling of
collecting tubules. However, in some cases the division is so complete as to give rise to two separate parts, each
with its own renal pelvis and ureter.

Classification
Ureteral duplication is either:

Partial - i.e. the two ureters drain into the bladder via a single common ureter. Partial, or incomplete,
ureteral duplication is rarely clinically significant.[2]

or

Complete - in which the two ureters drain separately. Complete ureteral duplication may result in one

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ureter opening normally into the bladder, and the other being ectopic, ending in the vagina, the urethra or
the vulval vestibule. These cases occur when the ureteric bud arises twice (rather than splitting).[3]

Prevalence
Duplicated ureter is the most common renal abnormality, occurring in approximately 1% of the population.[2]
Race: Duplicated ureter is more common in Caucasians than in African-Americans. Sex: Duplicated ureter is
more common in females. However, this may be due to the higher
frequency of urinary tract infections in females, leading to a higher rate
of diagnosis of duplicated ureter.

Clinical Presentation
Prenatally diagnosed hydronephrosis (fluid-filled kidneys) suggest post-
natal follow-up examination. The strongest neo-natal presentation is
urinary tract infection. A hydronephrotic kidney may present as a
palpable abdominal mass in the newborn, and may suggest an ectopic
ureter or ureterocele. In older children, ureteral duplication may present
as:

Urinary tract infection - most commonly due to vesicoureteral

reflux (flow of urine from the bladder into the ureter, rather than
vice versa).
One of a series of IVP films at 15
Urinary incontinence in females occurs in cases of ectopic ureter
minutes after injection of contrast
entering the vagina, urethra or vestibule. medium showed incomplete
duplication of left collecting system.
References
1. Siomou E. et al, Duplex collecting system diagnosed during the first 6 years of life after a first urinary tract infection: a
study of 63 children (http://www.medscape.com/medline/abstract/16407023), Journal of Urology, 2006; 175(2):678-81;
discussion 681-2
2. J. Gatti, J. Murphy, J. Williams, H. Koo, emedicine overview, Ureteral Duplication, Ureteral Ectopia, and Ureterocele
(http://emedicine.medscape.com/article/1017202-overview)
3. Sadler, T. W., Langman's medical embryology - 11th ed. p. 240, ISBN 978-0-7817-9069-7.

See also
Ureterocele
Ectopic ureter
Kidney development

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Categories: Ureter disorders

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