Ureteral duplication is a common anatomical abnormality where a patient has two ureters instead of one. It can cause urine flow problems, and surgery may be needed to address it. It is often diagnosed in the womb or after birth if the baby frequently suffers from urinary tract infections. Treatment plans vary depending on the patient’s condition and medical history.
Ureteral duplication, also called a 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 that both of these organs each have an extra ureter.
Patients who have a ureterocele often have a duplicating ureter. A ureterocele refers to the enlargement of the part of the ureter closest to the bladder. The opening of the ureter into the bladder is also abnormally narrowed. A ureterocele can interfere with the proper flow of urine and can cause urine to backflow into the ureter.
It is possible that a ureteral duplication is associated with genetics; however, the exact cause is unknown. Females tend to be more at risk of this medical condition than males, and usually, females will also have both kidneys affected. Typically, the condition is diagnosed in the womb with a prenatal ultrasound. This is an imaging test used to diagnose potential problems before birth. After birth, a duplication of the ureter can be suspected if the baby frequently suffers from urinary tract infections.
Children who also suffer from urinary tract infections will likely be prescribed a course of antibiotics. In severe cases, intravenous fluids may also be given. A urologist will evaluate the patient’s specific condition and medical history to determine a treatment plan. When surgery is needed, it is usually delayed until the patient is at least 12 to 12 months old. Newborns have very small bladders, which can complicate surgery and increase the risk of complications.
Patients with a duplication ureter who do not appear to suffer any adverse effects from the condition may not require treatment. If the ureterocele is severely constricting the ureter and causing a backflow of urine, the urine may need to be surgically drained. In some cases, the urologist may recommend removing the ureter with the ureterocele, leaving the duplicated, functioning ureter in place.
A variety of other surgeries can be used to address a ureteral duplication, including a cutaneous ureterostomy, in which the surgeon will detach the ureters where they connect to the bladder. They will protrude through an opening in the abdomen and urine will collect in external sacs. The patient will then undergo a second surgery to replace the ureters, and in some cases, a partial nephrectomy may also be needed to remove part of a damaged kidney.
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