Two Are No Different Than One

Ureteroscopy is safe and effective, no matter the ureteral anatomy, according to a Cleveland Clinic study.

A common abnormality

Ureteral duplication is a common congenital abnormality – albeit a relatively rare phenomenon – in the urinary tract, affecting about 1 percent of the population. Patients with known duplication are cautioned prior to surgery for urinary stone disease that the ureter may be “tight” and surgery may be more difficult.

Manoj Monga, MD, FACS, FRCS, Director, Cleveland Clinic’s Center of Endourology & Stone Diseases in the Glickman Urological & Kidney Institute, and his team undertook the first study to compare urolithiasis treatment outcomes in patients with and without ureteral duplication. “Two Are No Different Than One: Ureteral Duplication Appears to Have No Effect on Ureteroscopy Outcomes” was published in the Journal of Endourology.

Outcomes unaffected by anatomy

The team hypothesized that the complex anatomy of a duplicated ureter might decrease the efficacy and increase the risk of ureteroscopy (URS). A retrospective analysis of surgical outcomes of urolithiasis in patients with ureteral duplication revealed these patients had longer operative times, but preoperative knowledge of the abnormality did not affect operative time. The additional operating time was attributed to the surgeon gaining access to and fully examining each system as an independent renal unit.

“To our surprise, outcomes were the same whether patients had duplicated systems or not,” Dr. Monga says. “The safety and efficacy of the procedures were identical to those without duplication.”

Standard practice

This finding supports current practice and suggests that no additional imaging is necessary in patients with ureteral duplication. The study’s population of patients with this abnormality undergoing urinary stone treatment also represents the largest reported in the literature.
“Urologists do not need to caution patients with duplicated systems that outcomes with ureteroscopy may not be as effective,” Dr. Monga says. “Ureteroscopy is safe and effective in a patient with ureteral duplication.”