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Suggest treatment for duplex moiety of kidneys in an infant

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Posted on Wed, 23 Jul 2014
Question: My 3 month old son has a double collecting kidney system of the left kidney with mild dilation of the lower moiety. Renal pelvis is 4mm (was 5mm on 2 week u/s). Left distal ureter measures 2 mm and ends in a ureterocele measuring 7x6X7 (was 4x4x4 on 2 week u/s). Ultrasound indicates interval growth of kidney. No sign of infection or other issues. Impression of radiologist: unchanged left distal ureteral dilation and ureterocele. Doctor don’t seem perturbed (wait and see). Everything I read says that a urterocele should be treated. Are there cases where it can collapse/resolve itself or that it’s so small that it doesn't require treatment? Should preventative measures be taken?
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Answered by Dr. V. Sasanka (21 hours later)
Brief Answer:
Needs investigations

Detailed Answer:
Hi
I do understand your anxiety and to an extent it is justified.

Duplex moiety of kidneys are often associated with obstruction of one half of the kidney whole, the other half of the kidney gets urine refluxing up from the bladder. The reflux can be temporarily managed with low dose antibiotics till the child grows old enough where a decision to operate or not can be taken safely, and this is usually after the first year.

On the other hand there is no reason to not operate on the half of the kidney with the end with a ureterocoele if it is causing significant obstruction as uncorrected obstruction can damage function of kidney in an infant.

So in the case of your son, I guess the growth of the kidney being reasonably good, your doctor was not too worried but I suggest you get a few basic tests done to evaluate the degree of obstruction. This could be at least a urogram and maybe a diuretic nuclear renogram, and if there is evidence of significant obstruction on these tests, the ureterocoele can be opened up endoscopically. The entire system can later be repaired by means of what we call common sheath re-implantation by a paediatric urologist well versed in this procedure.

Hope I have been of help
All the best, and please let me know the progress.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. V. Sasanka

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Practicing since :1995

Answered : 529 Questions

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Suggest treatment for duplex moiety of kidneys in an infant

Brief Answer: Needs investigations Detailed Answer: Hi I do understand your anxiety and to an extent it is justified. Duplex moiety of kidneys are often associated with obstruction of one half of the kidney whole, the other half of the kidney gets urine refluxing up from the bladder. The reflux can be temporarily managed with low dose antibiotics till the child grows old enough where a decision to operate or not can be taken safely, and this is usually after the first year. On the other hand there is no reason to not operate on the half of the kidney with the end with a ureterocoele if it is causing significant obstruction as uncorrected obstruction can damage function of kidney in an infant. So in the case of your son, I guess the growth of the kidney being reasonably good, your doctor was not too worried but I suggest you get a few basic tests done to evaluate the degree of obstruction. This could be at least a urogram and maybe a diuretic nuclear renogram, and if there is evidence of significant obstruction on these tests, the ureterocoele can be opened up endoscopically. The entire system can later be repaired by means of what we call common sheath re-implantation by a paediatric urologist well versed in this procedure. Hope I have been of help All the best, and please let me know the progress.