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

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.