Surgical Treatment of Duplicated Collecting System in 185 Children: A Single-Center Experience

Abstract

Abstract Background Duplicated collecting system (DCS) is a common congenital urinary tract anomaly in children. It can manifest as complete duplicated collecting system (CDS) or incomplete duplicated collecting system (IDS). While many DCS cases are asymptomatic, some children experience complications such as hydronephrosis, urinary tract infections, incontinence, and vesicoureteral reflux (VUR), which are often associated other urinary tract anomalies, mainly affecting the upper pole moiety. Surgical intervention is frequently required, and various surgeries are now available. Patients and Methods: This retrospective study analyzed data from 185 pediatric patients with DCS who underwent surgical treatment between 2012 and 2021. The choice of surgical approach was based on a comprehensive evaluation by experienced pediatric urologists. The study included different procedures: upper pole heminephrectomy (UHN), endoscopic ureterocele incision (EUI), upper ureteric reimplantation (UIR), and pyeloureteroplasty (PUP). Result Results showed that UHN led to complete resolution of hydronephrosis and incontinence in 127 cases. However, 9 (7.1%) experienced febrile urinary tract infections, 5 (3.9%) experienced ureteral stump syndrome, 3 (2.4%) experienced residual renal atrophy and 8 (6.3%) required reoperations. Comparison between laparoscopic and open UHN revealed the benefits of laparoscopic techniques, including shorter hospitalization and fewer complications. EUI provided a minimally invasive option with significantly reduced hospitalization and resulted in reduced hydronephrosis, although 6 (17.6%) cases experienced febrile urinary tract infections (fUTIs) and 4 (11.8%) needed additional surgeries. UIR was successful in relieving incontinence and hydronephrosis, but 1 (5.9%) experienced fUTIs and 1 (5.9%) required reoperation. PUP also resulted in reduced hydronephrosis without complications. No statistically significant difference existed in rates of unplanned reoperations and fUTIs between UHN and nephron-sparing surgeries. Conclusion Our experience underscores the effectiveness and safety of UHN, especially when utilizing laparoscopic techniques, to treat DCS, resulting in fewer complications. Procedures like UIR, EUI, and PUP, designed to preserve the duplicated moiety, have proven safe and effective, minimizing renal trauma, and preserving renal function.