Ureteral duplications and ureteroceles

Abstract

Ureteral ectopia and ureterocele are the most common conditions associated with the upper pole of a duplex system, whereas primary vesicoureteral reflux and ureteropelvic junction obstruction with the lower pole. Asymptomatic infants with a duplex system associated with ureteral dilatation in any moiety should be started on antibiotic prophylaxis and undergo a basic workup including ultrasound scan of the urinary tract, voiding cystourethrography, and diuretic renography. Additional imaging may be useful when anatomical information is still necessary at the end of the basic workup. Management of lower pole conditions does not differ essentially from the corresponding condition in a single system. In case of ectopic ureters, we favor a dismembered extravesical reimplantation of the upper pole ureter. In case of ureterocele, conservative management can be offered to selected patients. Otherwise, endoscopic decompression is generally our first choice, but in patients with big ureteroceles and severe upper tract hydroureteronephrosis, upper pole partial nephrectomy seems a more effective procedure. In our experience, irrespective of the primary approach, once effective ureterocele decompression is achieved, recurrent febrile urinary tract infections are rare, and so is the need for further surgical procedures.