Duplicated collecting system
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| Duplicated collecting system Classification and external resources | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
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Duplicated collecting system is the most common upper urinary tract anomaly, affecting nearly 15% of the population.
Embryologically occurs when 2 separate ureteric buds arise from a single wolffian duct. The future lower pole ureter separates from Wolffian duct earlier and migrates superiorly and laterally as the urogenital sinus grows.
Weigert-Meyer rule for bladder insertion: the upper pole ureter inserts inferior and medial to lower ureter.
Alternatively, the 2 ureters may fuse to form a single ureter prior to inserting into the bladder, termed a bifid system.
The lower pole system is usually dominant, while the upper system may drain a single or few calices.
The upper pole ureter may demonstrate a ureterocele, which is associated with ureteral obstruction and recurrent UTIs in children. The upper pole ureter may also be ectopic or stenotic.
Symptoms
- Most patients are symptomatic and are diagnosed as an incidental finding.
- Vesicoureteral reflux
- Recurrent UTIs, with resultant parenchymal scarring
- Ureteropelvic junction obstruction
- Hydronephrosis, which may be severe enough to cause a palpable mass and hypertension
- Urinary incontinence with ectopic insertion in female
Diagnostic Findings
- Excretory urography may demonstrate the duplicated anatomy. Limitation is that a poorly functioning system may not excrete contrast and may resemble a mass.
- The drooping lily sign: inferolateral displacement of the opacified lower pole moiety in a duplex kidney from an obstructed (unopacified) upper pole moeity.
- Voiding cystourethrogram is usually diagnostic and may demonstrate ectopic insertion and reflux.
- Ultrasound is an easy, noninvasive exam that may show the duplex kidney and hydronephrosis. May not be able to differentiate between complete duplication and a bifid system.
- CT urography may demonstrate the duplicated system and show the location of bladder insertion for each moiety.
- MR urography may demonstrate the typical anatomic findings, but is an expensive alternative.
- Renal scintigraphy can show the anatomy as well as evaluate for renal function.
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References
- Glassberg KI, et al. Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol 1984; 132(6):1153-4.
- Callahan MJ. The drooping lily sign. Radiology. 2001 Apr;219(1):226-8.
- Sheth S and Fishman E. Multi-detector row CT of the kidneys and urinary tract: techniques and applications in the diagnosis of benign diseases. RadioGraphics 2004;24:e20.
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
