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{{Infobox_Disease |
{{Infobox_Disease |
   Name          = {{PAGENAME}} |
   Name          = {{PAGENAME}} |
   Image          = Duplicated-collecting-system-002.jpg|
   Image          = Duplicated-collecting-system-002.jpg|
   Caption        = Duplicated collecting system. <br> [http://www.radswiki.net Image courtesy of RadsWiki]|
   Caption        = Duplicated collecting system. <br> [http://www.radswiki.net Image courtesy of RadsWiki]|
  DiseasesDB    = |
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  ICD9          = |
  ICDO          = |
  OMIM          = |
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  eMedicineSubj  = |
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{{SI}}
'''For patient information, click [[Duplicated collecting system (patient information)|here]]'''
{{Duplicated collecting system}}
{{CMG}}
{{CMG}}


'''Associate Editor-In-Chief:''' {{CZ}}
'''Contributors:''' [[User:zorkun|Cafer Zorkun]] M.D., PhD.
==[[Duplicated collecting system overview|Overview]]==


{{Editor Help}}
==[[Duplicated collecting system historical perspective|Historical Perspective]]==


==Overview==
==[[Duplicated collecting system classification|Classification]]==


'''Duplicated collecting system''' is the most common upper urinary tract anomaly, affecting nearly 15% of the population. <ref>Glassberg KI, et al. Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol 1984; 132(6):1153-4.</ref> <ref>Callahan MJ. The drooping lily sign. Radiology. 2001 Apr;219(1):226-8.</ref> <ref>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.
==[[Duplicated collecting system pathophysiology|Pathophysiology]]==
</ref>


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.
==[[Duplicated collecting system causes|Causes]]==


'''Weigert-Meyer rule''' for bladder insertion: the upper pole ureter inserts inferior and medial to lower ureter.
==[[Duplicated collecting system differential diagnosis|Differentiating Duplicated collecting system from other Diseases]]==


Alternatively, the 2 ureters may fuse to form a single ureter prior to inserting into the bladder, termed a bifid system.
==[[Duplicated collecting system epidemiology and demographics|Epidemiology and Demographics]]==


The lower pole system is usually dominant, while the upper system may drain a single or few calices.
==[[Duplicated collecting system natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


The upper pole ureter may demonstrate a [[ureterocele]], which is associated with ureteral obstruction and recurrent [[UTI]]s in children. The upper pole ureter may also be ectopic or stenotic.
==Diagnosis==
[[Duplicated collecting system history and symptoms|History and Symptoms]] | [[Duplicated collecting system physical examination|Physical Examination]] | [[Duplicated collecting system laboratory findings|Laboratory Findings]] | [[Duplicated collecting system KUB x ray|KUB X Ray]] | [[Duplicated collecting system CT|CT]] | [[Duplicated collecting system MRI|MRI]] | [[Duplicated collecting system echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Duplicated collecting system other imaging findings|Other Imaging Findings]] | [[Duplicated collecting system other diagnostic studies|Other Diagnostic Studies]]


==Symptoms==
==Treatment==
[[Duplicated collecting system medical therapy|Medical Therapy]] | [[Duplicated collecting system surgery|Surgery]] | [[Duplicated collecting system cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] |  [[Duplicated collecting system future or investigational therapies|Future or Investigational Therapies]]


*Most patients are symptomatic and are diagnosed as an incidental finding.
==Case Studies==
*[[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==
[[Duplicated collecting system case study one|Case #1]]
 
*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.
 
[http://www.radswiki.net Images courtesy of RadsWiki]
 
<gallery>
Image:Duplicated-collecting-system-001.jpg|Duplicated collecting system
Image:Duplicated-collecting-system-002.jpg|Duplicated collecting system
</gallery>
 
==References==
{{Reflist|2}}
    
    
{{SIB}}   
[[Category:Needs content]]
 
[[Category:Disease]]
[[Category:Congenital disorders]]
[[Category:Congenital disorders]]
[[Category:Nephrology]]
[[Category:Nephrology]]

Latest revision as of 17:16, 28 December 2012

Duplicated collecting system
Duplicated collecting system.
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Contributors: Cafer Zorkun M.D., PhD.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Duplicated collecting system from other Diseases

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | KUB X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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