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Ureteral duplication, also called a duplex collecting system, is a relatively common anatomical anomaly 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 one ureter to drain urine from that organ to the bladder, but sometimes both kidneys are affected so that both of these organs each has an extra ureter.
Patients who have a ureterocele often have ureteral duplication. A ureterocele refers to the enlargement of the part of the ureter that is closest to the bladder. The opening of the ureter into the bladder is also abnormally narrowed. Ureteroceles can interfere with the proper flow of urine, and may cause the urine to backflow up the ureter.
It is possible that a ureteral duplication is associated with genetics; however, the exact cause is unknown. Females tend to to be at a higher 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 that is used to diagnose potential problems prior to birth. After birth, a ureteral duplication may be suspected if the child 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, they may also be given intravenous fluids. A urologist will assess the patient's specific condition and his medical history to determine a treatment plan. When surgery is necessary, it is generally delayed until the patient is at least six to 12 months old. Infants have a very small bladder, which can complicate surgery and increase the risk of complications.
Patients with ureteral duplication who do not appear to suffer 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 duplicate, functioning ureter in place.
A variety of other surgeries may be used to address a ureteral duplication, including a cutaneous ureterostomy, where the surgeon will detach the ureters at the point where they connect to the bladder. They will protrude through an opening in the abdomen, and the urine collects in external bags. The patient will later undergo a second surgery to replace the ureters, and in some cases, a partial nephrectomy may also be needed to remove a portion of a damaged kidney.