Çift toplayıcı sistem ve çift üreter

Özet

Çift toplayıcı sistem, böbreğin iki pelvikaliksiyel bölümünün ayrı veya kısmen birleşen üreterlerle drene olduğu doğumsal varyanttır. Çoğu olguda tesadüfen görülür; üst kutup obstrüksiyonu, üreterosel veya ektopik açılım klinik önemini artırır. BT ürografi, üreterlerin birleşme yerini ve mesane içindeki ya da dışındaki sonlanımını haritalamada yararlıdır. İki kolun tek üreter sanılması obstrüksiyonun hangi renal bölümü etkilediğini ve cerrahi anatomiyi belirsiz bırakabilir.

Faz ve pencere

Ekskresyon tanısal

Boşaltım fazı, opasifiye kalikslerden iki ayrı üreter kolunu ve olası birleşme noktasını izlemeyi; tam duplikasyonda iki distal yolu ayrı sonlanıma kadar takip etmeyi sağlar.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Renal sinüs içinde üst ve alt kutup toplayıcı sistemlerinin ayrışması.
• Bifid üreterde iki proksimal kolun mesaneye ulaşmadan tek üreter gövdesinde birleşmesi.
• Tam duplikasyonda iki üreter ayrı seyreder ve ayrı sonlanır; sonlanımlar mesane içinde ayrı ağızlar olabileceği gibi, üst pol üreteri ektopik olarak mesane dışında da açılabilir.
• Tam duplikasyonda Weigert–Meyer düzenine göre üst pol üreteri genellikle alt pol üreterine göre daha inferomedial sonlanır; mesane dışı ektopik açılım ayrıca değerlendirilir.
• Üst kutup sisteminde hidroureteronefroz ve küçük ya da displastik parankim.
• Üreterosel kesesi veya ektopik üreter açılımının eşlik etmesi.
• Alt kutup toplayıcı sisteminde reflü/obstrüksiyonla uyumlu genişleme; tek başına BT reflüyü kanıtlamaz.

Normalde

Normal böbrekte renal pelvis, kaliksler ve tek üreter kesintisiz bir toplayıcı yol oluşturur; aynı taraflı ikinci üreteral kontrast kolu görülmez. Koronal BT ürografide renal hilustan mesane trigonu yönüne tek opasifiye üreter izlenmesini, duplikasyon şüphesinde ise iki kolun hangi düzeyde birleştiğini veya ayrı sonlandığını karşılaştırın.

Ayırıcı tanı

Ekstrarenal pelvis

geniş pelvis vardır, iki ayrı kaliks grubu ve üreter kolu yoktur.

Hidroureter

üreterde genişleme bulgusudur; çift toplayıcı sistemde üst kutup üreterinde de görülebilir.

Üreterosel

çift toplayıcı sisteme eşlik edebilen bir komplikasyondur.

Tuzaklar

• Boşaltım fazında az opasifiye ince bir kol görünmeyebilir; opasifikasyon eksikliğini yokluk saymayın.
• Üst kutup parankimi çok ince veya işlevsizse ilgili üreter kontrastlanmayabilir; koronal yumuşak doku kesitlerinde izleyin.
• Üreterin seyrini değerlendirirken renal toplayıcı sistem anatomisini ve drenaj yolunu kesitsel görüntülerde izleyin.
• Üst pol üreterinin inferomedial yerleşimi Weigert–Meyer düzeninin tipik bileşenidir; “ektopik üreter” ise mesane trigonu dışında sonlanan üreteri tanımlar ve bu iki ifade eş anlamlı değildir.

Kendini dene

1. BT ürografide üst ve alt kutup kolları orta üreterde birleşiyor. Bu anatomi nasıl adlandırılır?

   • Bifid üreter
   • Tam duplikasyon
   • Ektopik üreter
   • Üreterosel
   Cevabı göster

   Bifid üreter. İki proksimal kol mesaneye varmadan birleştiği için inkomplet duplikasyon, yani bifid üreterdir. Tam duplikasyonda iki distal üreter ayrı devam eder; ektopik üreter anormal sonlanımı, üreterosel ise distal kistik genişlemeyi tanımlar.

2. Ayrı iki üreterden üst kutup kolu mesanede daha aşağı ve mediale açılıyor. En uygun yorum hangisidir?

   • Weigert-Meyer düzeni
   • Ekstrarenal pelvis
   • Üreteral divertikül
   • Retrokaval üreter
   Cevabı göster

   Weigert-Meyer düzeni. Tam duplikasyonda üst kutup üreteri tipik olarak daha kaudal-medial konumda açılır. Diğer seçenekler iki ayrı distal üreterin bu yerleşim düzenini açıklamaz.

İlgili konular

• Üreter taşı
• Üreter yaralanması ve idrar kaçağı
• Üreterosel

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 3 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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