Abstract
duplicatedcollecting system, characterized by the presence of two separate pelvicalyceal systems within a single kidney, is a rare congenital anomaly. Surgical intervention, such as open heminephrectomy, is often required in cases where complications arise, including recurrent infections, significant obstruction, or reflux.We report the case of a 29-year-old female who presented with recurrent urinary tract infections and flank pain with reflux. Imaging studies revealed a duplicated collecting system on the right side with significantlypoor functioning upper moiety while preserving the healthy lower moiety. The patient tolerated the procedure well, with no intraoperative complications. Postoperative recovery was uneventful, and follow-up imaging confirmed the successful removal of the affected renal segment. The patient remained symptom-free at the two-month follow-up. Open heminephrectomy remains a viable surgical option for managing a symptomatic duplicated collecting system.IntroductionDuplex anomalies of the urinary tract are a common finding in girls with urinary tract infections. A duplex anomaly occurred in one of 12 patients (8% of the total group with urinary tract infection)1(.The duplex system could co-exist with other defects. Obstruction in the collecting system, urinary tract calculus, ureterocele, and vesicoureteral reflux can all complicate the duplex ureter(2).Duplex systems may have a broad spectrum of clinical presentations and significance. CDS may be associated with VUR, or may be ectopic or subtended by an ectopic ureterocele(3).The imaging diagnosis of an abnormal duplex collecting system is usually straightforward and depends on demonstrating either the abnormal upper moiety (directly with sonography or indirectly with excretory urography or both) or the lower moiety(4). Many patients with duplex kidneys are asymptomatic and have no impairmentof renal function. Those who are of concern before birth or afterdelivery (postnatal) usually have complications related to abnormal implantation of one or both ureters. The upper pole ureter can form a ureterocele within the bladder causing obstruction, resulting in little or no function of the upper pole. The lower pole ureter may have short intravesical segments that produce vesicoureteral reflux (VUR). Duplex systems that have this complication also have ultrasound (US) findings that facilitate their prenatal detection. Clinically significant duplication of the collecting system may manifest prenatally with hydronephrosis of the upper pole and dilatation of the upper polar ureter, hydronephrosis of the lower pole, or ureterocele within the bladder(5).Management is carried out based on the symptoms experienced by the patient and by looking at kidney function. If symptoms such as urinary tract obstruction are not found and kidney function is normal, then surgical management is not necessary (6). As for whethersurgery is needed, it can be through urethrectomyor superior polus heminephrectomy(7).Case reportThe patient is a 29-year-old female presenting with intermittent right-sided flank pain described as dull, aching, and occasionally sharp, which worsens during UTI episodes, prolonged sitting, and physical activity. She reports frequent urination (polyuria), urgency to urinate, and painful urination (dysuria). Her medical history includes ureteral reimplantation for an ectopic ureter position, with no known allergies or significant family history of renal or urological conditions. On physical examination, she appears well nourished, alert, and oriented, with normal vital signs. Abdominal examination reveals tenderness over the right costovertebral angle (CVA) without rebound tenderness or palpable renal masses, and dullness to percussion over the left CVA.CT scan(Abdomen/Pelvis). Figure1showsa double collecting system in the right kidney.Identified hydroureter in the proximal part of the right ureter and demonstrated two moieties (upper and lower) on the right-sidePyelogram.Figure 2indicatesthat the function of both the right and left kidneys