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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (4): 754-761. doi: 10.19723/j.issn.1671-167X.2026.04.011

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Analysis of endoscopic surgical strategies for duplex kidney and ureteral malformation complicated with upper urinary tract calculi

Xinji YANG1, Xiushi LIN1, Zhifei XIE2, Yuqing LIU1, Chunlei XIAO1, Shudong ZHANG1, Xiaofei HOU1,*(), Min QIU1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Urology, Tianjin Wuqing District Second People' s Hospital, Tianjin 301700, China
  • Received:2026-02-22 Online:2026-08-18 Published:2026-05-19
  • Contact: Xiaofei HOU, Min QIU
  • Supported by:
    the Wu Jieping Medical Foundation Special Fund for Clinical Research(320.6750.2022-03-45)

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Abstract:

Objective: To investigate the endoscopic surgical management strategies for duplex kidney and ureteral duplication anomalies complicated by upper urinary tract calculi, to summarize individualized diagnostic and therapeutic experiences for different anomaly subtypes, and to provide a reference for standardized clinical management of this condition. Methods: The clinical data of patients with duplex kidney and ureteral duplication anomalies and upper urinary tract calculi who underwent endoscopic surgery at the Department of Urology, Peking University Third Hospital from November 2012 to December 2025 were retrospectively analyzed. Baseline characteristics, imaging findings, perioperative parameters, complications, and changes in renal function were collected. Endoscopic surgical techniques and key diagnostic and therapeutic points for different anomaly subtypes were summarized. Statistical analysis was performed using SPSS 22.0 and R 3.6.1 software. Results: A total of 38 patients were enrolled, including 16 males and 22 females, with a mean age of (49.92±14.27) years. The median follow-up duration was 17.80 months (1.60-41.90). The predominant clinical symptom was flank pain (32 cases, 84.21%). The most common anomaly subtype was unilateral incomplete duplex kidney and ureteral duplication (24 cases, 63.16%). Based on the anomaly subtype and stone characteristics, all the patients underwent precise preoperative assessment using CT urography and other imaging modalities, and indivi-dualized surgical approaches were selected: In the study, 15 patients underwent ureteroscopic lithotripsy (URL), 15 underwent flexible ureteroscopic lithotripsy (FURL), 7 underwent percutaneous nephrolithotomy (PCNL), and 1 patient received PCNL combined with FURL. The median operative time was 74.00 (64.75-92.50) min, the median intraoperative blood loss was 2.00 (1.00-4.25) mL, and the median postoperative hospital stay was 3.00 (2.00-5.75) d. The overall postoperative stone-free rate was 94.74%. No severe perioperative complications occurred. Postoperative fever occurred in 14 patients (36.84%), all of whom recovered after symptomatic treatment. Postoperative serum creatinine levels were significantly lower than preoperative levels (P < 0.05), indicating significant improvement in renal function. Conclusion: Endoscopic surgery is safe and effective for the treatment of duplex kidney and ureteral duplication anomalies complicated by upper urinary tract calculi, offering advantages of minimal trauma, rapid recovery, and a high stone-free rate. The strategy of "precise diagnosis-individualized surgical approach selection" allows the formulation of tailored treatment plans for different anomaly subtypes and is worthy of clinical promotion and application.

Key words: Duplex kidney and ureteral duplication, Upper urinary tract calculi, Ureteroscopy, Percutaneous nephrolithotomy, Endoscopic surgery

CLC Number: 

  • R693.1

Table 1

Demographic and baseline clinical characteristics of patients with duplex kidney and ureteral malformation complicated with upper urinary tract calculi"

Variables Patients (n=38)
Gender, n (%)
  Male 16 (42.11)
  Female 22 (57.89)
Age/years, $\bar x \pm s$ 49.92±14.27
BMI/(kg/m2), M (P25，P75) 25.01 (22.63, 26.47)
Symptoms, n (%)
  Low back pain 32 (84.21)
  Lower urinary tract irritation symptoms 10 (26.32)
  Lower urinary tract obstruction symptoms 3 (7.89)
  Hematuria 12 (31.58)
  Fever 6 (15.79)
  Nausea and vomiting 7 (18.42)
  Detected during physical examination 3 (7.89)
Duration of symptoms/d, M (P25，P75) 30.00 (21.50, 165.00)
Basic medical history, n (%)
  Hypertension 13 (34.21)
  Diabetes mellitus 6 (15.79)
  Coronary heart disease 4 (10.53)

Table 2

Preoperative imaging evaluation of duplex kidney and ureteral malformation types, stone characteristics and hydronephrosis"

Variables Patients (n=38)
Side of Ureteral duplication, n (%)
  Left 12 (31.58)
  Right 17 (44.74)
  Bilateral 9 (23.68)
Type of Ureteral duplication, n (%)
  Unilateral incompletely 24 (63.16)
  Unilateral completely 4 (10.53)
  Bilateral incompletely 1 (2.63)
  Bilateral completely 3 (7.89)
  Bilateral completely and contralateral incompletely 5 (13.16)
  Unilateral inverted Y 1 (2.63)
Stone location, n (%)
  Calices renales of the upper kidney 10 (26.32)
  Calices renales of the lower kidney 8 (21.05)
  Ureteropelvic junction 6 (15.79)
  Ureter 11 (28.95)
  Multiple locations 3 (7.89)
Number of stones, n (%)
  1 21 (55.26)
  2 2 (5.26)
  Multiple 15 (39.48)
Maximum stone diameter/cm, M (P25，P75) 1.06 (0.84, 1.48)
Stone CT value/HU, $\bar x \pm s$ 897.82±348.62
Pelvic hydronephrosis, n (%) 23 (60.53)
Hydronephrosis size/cm, M (P25，P75) 3.43 (2.96, 3.79)

Figure 1

CT three-dimensional reconstruction showing different types of renal pelvis and ureter duplication malformations A, incomplete duplication of the left renal pelvis and ureter; B, incomplete duplication of the left renal pelvis and ureter, with complete duplication of the right renal pelvis and ureter; C, inverted Y-shaped duplicated ureter on the right side."

Table 3

Summary of endoscopic surgical approaches, intraoperative management and special situations"

Variables Patients (n=38)
ASA grade, n (%)
  Ⅰ 21 (55.26)
  Ⅱ 17 (44.74)
Anesthesia method, n (%)
  General anesthesia 25 (65.79)
  Spinal anesthesia 13 (34.21)
Surgical method, n (%)
  URL 15 (39.47)
  FURL 15 (39.47)
  PCNL 7 (18.43)
  PCNL+FURL 1 (2.63)
Intraoperative special conditions, n (%)
  Ureteral stricture 19 (50.00)
  Ureteral orifice cyst 3 (7.89)
  Complete impaction 2 (5.30)
  Stricture incision 3 (7.90)
  Cyst incision 1 (2.63)
  Balloon dilation 2 (5.26)
Surgical time/min, M (P25，P75) 74.00 (64.75, 92.50)
Estimated blood loss/mL, M (P25，P75) 2.0 (1.00, 4.25)

Figure 2

Intraoperative ureteroscopic views of duplex kidney and ureter malformation A, ureteroscopically, two ureteral tracts can be visualized; B, a cyst is visible at the orifice of the duplicated ureter; C, inverted Y-shaped duplicated ureter."

Table 4

Postoperative stone clearance, complications and renal function improvement"

Variables Patients (n=38)
Postoperative fever, n (%) 14 (36.84)
Complete stone clearance, n (%) 36 (94.74)
Staged Surgery, n (%) 1 (2.63)
Follow-up time/months, M (P25，P75) 17.80 (1.60, 41.90)
Postoperative extubation time/d, M (P25，P75) 37.00 (31.25, 42.25)
Postoperative hospital stay/d, M (P25，P75) 3.00 (2.00, 5.75)
Postoperative creatinine decline, n (%) 32 (84.21)

Table 5

Comparison of renal function related laboratory parameters before and after surgery"

Variable Preoperative Postoperative V P value
Creatinine/(μmol/L), M (P25，P75) 75.50 (65.50, 89.70) 70.00 (57.00, 80.00) 43 0.007
Glomerular filtration rate/[mL/(min·1.73 m2)], M (P25，P75) 92.77 (82.79, 102.75) 100.00 (93.00, 113.00) 135 0.033
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