Renal duplex system in pediatric population: management and long-term follow-up

Background. Duplex system is a duplication of renal parenchyma, pelvis and collecting system. It could be complete, if ureters lead to bladder separately or incomplete, if they joint before coming out. This study aims duplex system management evaluation, defining indications of conservative or demolitive therapy, and results. Materials and methods. At the section of pediatric surgery of University of Siena we have observed 27 patients with duplex system from January 1980 to May 2011: 7 male (26%) and 20 female (74%), 18 (67%) with complete duplicity, 9 (33%) with incomplete one. Patients were divided into 2 groups: the first one was composed by 12 children (44%), they had negative diagnostic exams for alterations of renal function and associated diseases and no symptoms;the second group had 15 children (56%) whose diagnostic-therapeutic iter was based on associated malformations and symptoms of each case. We found: 5 RVU (33%) with 1 Hutch diverticulum; 5 ureteroceles (33%); 3 ectopic ureters (20%); 4 megaureters (26%), 6 renal dysplasia and upper pole function <10% (40%). Results. Children belonging to second group were treated in different ways. 5 babies (33%) with RVU were approached with submeatal infiltration; 1 baby (7%) with ureterocele was treated with excision of the malformation and Cohen reimplatation; 2 ureteroceles (13%) were incised by transurethral approach and RVU appeared, 1 of them was then treated with eminephroureterectomy; in 1 case of ureterocele (7%)and 1 of ectopic ureter (7%) no treatment was undertaken and 1 baby with ureterocele (7%) needed eminephoureterectomy; 4 kidneys (26%) with upper pole impaired function required eminephroureterectomy. All second group patients, except 3, had a 2-16 years follow-up and they showed normal growth and no symptoms. First group children had negative exams and excellent clinic conditions. Conclusions. Our results suggest that management should be decided on patient’s age, clinic presentation and associated diseases.