BERKELEY, CA (UroToday.com) - Surgery of duplicated systems is uncommon in the adult population and for this reason I thought this paper would be interesting for the pediatric forum. Typically an operation for a duplex system entails an ablative procedure at the kidney level or a reimplantation at the bladder level. This group from India reported their preliminary experience with transperitoneal laparoscopic pyeloureterostomy for a duplicated collecting system. Since January 2003, two adult patients with incomplete duplication of ureter with ureteropelvic junction obstruction of the lower moiety and a 4-month-old male baby with complete duplication of the ureter with reflux in the lower moiety underwent transperitoneal laparoscopic pyeloureterostomy. The baby also had excision of the lower moiety ureter. There were no intraoperative or postoperative morbidity to comment upon. Follow-up imaging revealed good drainage of the systems. It confirms that with increasing experience in laparoscopy, reconstructive urologic procedures are possible even in infants. Over the past year, I have utilized an upper to lower pole ureteroyelostomy in a number of cases where the upper pole moiety had excellent function. Albeit the overall function of the upper pole moieties have minimal contribution, the reconstruction adds little risk to the lower moiety in comparison to a heminephrectomy that carries risk of injury to the lower pole vessels. In the case of the lower pole moiety, it does contribute the majority of function for that side and should be preserved if it is viable. I feel that having the option to ablate or reconstruct allows us make the best decision for our patients without being obligated to one or two maneuvers for a curative outcome.

Journal of Endourology 20(2): 115-118, Feb 2006