Ipsilateral ureteroureterostomy versus upper moiety heminephrectomy (and proximal ureterectomy) for a complete duplex system of the kidney: a mini-review A mini review

Abstract

Background: A complete duplicated renal collecting system associated with an ectopic ureter or an ureterocele is a rare congenital abnormality which may require surgical intervention to resolve symptoms or improve drainage of an obstructed renal unit at risk of loss. Corrective surgery can be divided into upper tract, lower tract, or combined approaches, with the decision largely dependent upon clinical context. This review set out to describe the differences in outcomes between approaches and hence provide clarity in terms of decision-making, specifically regarding symptomatic or obstructed upper moieties.

Materials and methods: This mini-review relied on a predefined search strategy of the Ovid MEDLINE database to select appropriate articles to allow for a comparison between these two interventions. The predefined medical subject headings for this search included “duplicated ureter”, “duplex system”, “ipsilateral ureteroureterostomy”, “upper pole heminephrectomy”, and “upper pole nephrectomy”. The search involved two reviewers working independently.

Results: Based on the available evidence, a direct comparison between differing approaches is not feasible. A lower tract approach in the form of an ipsilateral ureteroureterostomy (IUU), regardless of upper moiety function, is a safe procedure with rates of postoperative febrile urinary tract infections (UTI) and requirement for reoperation comparable to an upper moiety heminephrectomy (UMH). An IUU has a lower risk of lower moiety loss compared to a UMH. Lower moiety hydronephrosis, ureterocele and concomitant bladder reconstruction or re-implantation are predictors of adverse outcomes in patients undergoing an IUU.

Conclusion: This review confirms the safety of a lower tract approach in managing patients with a complete duplicated collecting system. Given its lower risk of damage to the remaining renal unit, it should be considered, provided no significant lower moiety pathology contraindicates its utilisation.