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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 3  |  Page : 608-610
Bilateral partial duplex collecting system in horseshoe kidney with stone in the left upper and lower moiety: An unusual association


Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., India

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Date of Web Publication20-May-2015
 

How to cite this article:
Singh SK, Kumar A. Bilateral partial duplex collecting system in horseshoe kidney with stone in the left upper and lower moiety: An unusual association. Saudi J Kidney Dis Transpl 2015;26:608-10

How to cite this URL:
Singh SK, Kumar A. Bilateral partial duplex collecting system in horseshoe kidney with stone in the left upper and lower moiety: An unusual association. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 Jun 23];26:608-10. Available from: https://www.sjkdt.org/text.asp?2015/26/3/608/157415
To the Editor,

A horseshoe kidney is the most common congenital renal fusion anomaly affecting approximately one in 400 live births. [1] Many affected individuals are asymptomatic. However, these kidneys are more likely than normal kidneys to have associated problems of stones and uretero-pelvic junction obstruction (UPJO) that may necessitate surgical intervention.

A 34-year-old male with no co-morbidity presented with history of left flank pain. An ultrasound evaluation of the kidney, ureter and bladder (KUB) region showed that the left kidney was 145 mm × 45 mm gross hydronephrosis with a thin cortex with multiple calculi, the largest being 25 mm in middle calyx; the right kidney was normal in size and shape with no hydronephrosis. Right partial incomplete duplication was seen with left nonexcreting moiety of horseshoe kidney with renal stone on intravenous pyelography [Figure 1]a and b. The glomerular filtration rate for the right kidney was 73 mL/min and for the left kidney was 14 mL/min. A computed tomography (CT) scan of the KUB region showed left gross hydro-nephrotic moiety with stone [Figure 2]a. He underwent left-sided percutaneous nephrolithomy. On cystoscopy, single ureteric orifices were seen on both sides. On the left side, by retrograde pyelogram only upper system was visualized with non-opacification of the inferior calyx. A second ureter was seen on retrograde pyelogram (RGP) from the level of the lower sacro-iliac joint. Stones were removed [Figure 2]. [Figure 1] and [Figure 2]
Figure 1:

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Figure 2:

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The prevalence of partial duplication is 0.6%, while complete duplication of the ureters occurs in 0.2% of live births. [2] Bifurcation of a single ureteral bud before the ampulla bifurcates results in a duplex kidney with a bifid renal pelvis or bifid ureter. [3] Congenital anomalies of the kidneys include a group of socalled fusion anomalies, in which both kidneys are fused together in early embryonic life. Fusion anomalies of the kidneys can generally be placed into two categories: Horseshoe kidney and its variants and crossed fused ectopia. [2],[3] Horseshoe kidney is generally differentiated from crossed fused ectopia, in which both fused kidneys lie on one side of the spine and the ureter of the crossed kidney crosses the mid-midline to enter the bladder. Symptoms are typically related to hydronephrosis, infection or calculus formation. The most common symptom is vague abdominal pain that may radiate to the lower lumbar region. Urinary tract infections occur in 30% of patients and calculi have been noted in 20-80% of patients. [1]

There were only five reported cases of duplex collecting systems in horseshoe kidneys, to the best of our knowledge. Four reported cases had common features, including an ureterocele in the distal end of the upper pole ureter. Only one of the cases was an adult and the other three involved were children. The fifth case was a horseshoe kidney with a duplex system without an ureterocele. [4],[5],[6],[7] Management of patients with duplicated collecting systems and/or horseshoe kidneys is largely dependent on the symptoms and clinical presentations. Our particular patient was found to have a left renal stone. He underwent percutaneous nephrolithotomy.

 
   References Top

1.
Bauer SB. Anomalies of the upper urinary tract. In Campbell-Walsh Urology. 9th ed. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Philadelphia: Saunders Elsevier; 2007; p. 3283.  Back to cited text no. 1
    
2.
Glassberg KI, Braren V, Duckett JW. Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol 1984;132:1153-4.  Back to cited text no. 2
    
3.
Bruno D, Delvecchio FC, Preminger GM. Successful management of lower-pole moiety ureteropelvic junction obstruction in a partially duplicated collecting system using minimally invasive retrograde endoscopic techniques. J Endourol 2000;14:727-30.  Back to cited text no. 3
    
4.
Segura JW, Kelalis PP, Burke EC. Horseshoe kidney in children. J Urol 1972;108:333-6.  Back to cited text no. 4
    
5.
Sumner TE, Volberg FM, Munitz A, Harrison LH, Mashburn AM. Unilateral duplex horseshoe kidney with ectopic ureterocele. South Med J 1985;78:199-201.  Back to cited text no. 5
    
6.
Mikuma N, Adachi H, Takatsuka K, Yokoo A, Wada H, Takahashi A. Ectopic ureterocele with a horseshoe kidney in an adult. Int J Urol 1996;3:243-4.  Back to cited text no. 6
    
7.
Chiang G, Kaplan G. Management of ectopic ureterocele with horseshoe kidney. J Pediatr Urol 2009;5:400-1.  Back to cited text no. 7
    

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Correspondence Address:
Dr. Sanjeet Kumar Singh
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P.
India
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DOI: 10.4103/1319-2442.157415

PMID: 26022041

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