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67th Annual Meeting Abstracts
Novel Management of Inverted-Y-Ureteral Duplication
Jyoti Upadhyay1, *Amanda Burnette1, *Greg Spana2, *Margaret Roth2, Maryellen Sheridan, RN2, *Bijan Shekarriz1
1Children's Hospital of the Kings Daughter, Eastern Virginia Medical School, Norfolk, VA;2University Hospital of New York, Syracuse, NY
Introduction:
There are no reported studies on the appropriate modality of detection of urinary incontinence caused by inverted-y-duplications. MRI/MRU (Magnetic Resonance Imaging with Urogram), with exam under anesthesia is the modality of choice for ectopic ureters in duplex systems. The best modality for detection of inverted-y-duplication, is not clear.
Materials & Methods:
We report on a series of five consecutive adolescent females (ages 14-17, mean 16) treated by one surgeon from 2002-2009 for refractory continuous urinary incontinence after lengthy negative diagnostic workup. High pressure vaginograms were performed with installation volumes ranging from 150-300cc diluted contrast with a large Foley catheter with the balloon inflated (20-30cc). Upon detection of inverted-y-duplication, laparoscopic excision was utilized.
Results:
In three of the five patients, high pressure vaginogram detected an inverted-y-duplication with ectopia to the vaginal forniceal cuff. In two of the five patients, vaginograms detected ectopic ureter of a duplex system. Two of the three inverted-y-duplications were treated laparoscopically with ectopic segment excision. One patient was lost to follow-up. Two patients underwent partial nephrectomy for poor functioning upper pole. All four patients who underwent surgery had complete resolution of urinary incontinence. In all three inverted-y-duplications, MRI/MRU failed to detect the anomalie.
Conclusion:
We report the first utilization of high pressure vaginogram in detection of inverted-y-duplications in a subset of patients with continuous urinary incontinence. We also present a novel, minimally invasive laparoscopic approach to the treatment of this anomalie. High pressure vaginogram and laparoscopy should be in the armamentary of treatment of inverted-y-duplication.
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