Personalized Surgical Management Offers Full Restitution and Unimpaired Quality of Life to Patients with Duplex Kidneys and Associated Pathologies: 30-year Follow-up at a Tertiary Referral Center

Management of duplex kidney (DK) and associated pathologies (APs) is complex and highly individual. The common surgical approaches are well established, and complication and reoperation rates are generally low. If a personalized approach is used, patients with DK and symptomatic APs can expect full bodily integrity and good quality of life. Prospective trials to compare various approaches in specific settings would be useful. Duplex kidneys may be associated with additional pathologies with an indication for surgery. Various surgical approaches have been described. However, little is known about long-term outcomes and quality of life (QoL) for these patients. To present long-term outcomes and QoL data up to 30 yr after surgical treatment of duplex kidneys and associated pathologies. We collected clinical and operative data for all patients who underwent surgery for complicated duplex kidney at our institution from 1990 to 2018. All patients were invited for a follow-up examination or telephone interview. We evaluated renal function, clinical outcomes, residual dilation of the upper urinary tract, and health-related QoL. Of the 176 patients included, 173 were available for follow-up (mean 140.5 mo). Surgical treatment involved an upper-tract, lower-tract, or combined approach in 11%, 56%, and 33% of cases, respectively. Rates of perioperative complications (8%) and secondary surgery (10%) were low. Overall, 95% of our patients achieved full restitution. Renal function was preserved in all cases, with recurrent urinary tract infections reported by just 2% and urinary incontinence by 1%. Good health-related QoL was reported by 98% of patients. Those without full restitution included six patients who underwent total nephrectomy and two boys who underwent multiple surgeries and urinary diversion. Our results are limited by their retrospective nature, including partly incomplete data sets. Management of duplex kidneys and associated pathologies is complex and highly individual. By planning a personal approach for each patient it is possible to achieve full bodily integrity and good QoL for most of these patients. Almost all patients undergoing surgery for duplex kidneys and associated pathologies will lead a life without body impairment and good quality of life. This trial is registered in the German Clinical Trials Register as DRKS00022542.