UROLOGICAL PROBLEMS IN CONJOINED TWINS

Objectives To review the urological abnormalities in conjoined twins, a rare congenital abnormality arising from an incomplete separation of a pair of monozygotic twins, and who can be joined from the head to t he pelvis with varying degrees of union. Patients and methods The reco rds and urological anomalies of conjoined twins presenting from 1985 t o 1995 were reviewed retrospectively and the management and surgical r econstruction described. Results Seven of 11 sets of conjoined twins u nderwent surgical exploration. Complex urological problems occurred in all twins with omphalo-ischiopagus. The urological anomalies were: Se t 1; both twins had one lateral crossed fused renal ectopia with uncro ssed ureters draining into a single bladder with one urethra. They had one set of genitalia. Each twin received one crossed fused ectopic ki dney, half the bladder and genitalia, with one retaining the urethra a nd one a vesicostomy. Set 2; these twins had four kidneys (two lateral and two central that were fused), four meters (two of which crossed) and these drained into two sagittal bladders that emptied by one ureth ra associated with a single set of external genitalia containing three corpora cavernosa. At separation, the crossed ureters were re-routed, each received a bladder and the genitalia were split. Set 3; there we re four kidneys with two crossed meters draining into two collateral b ladders, there was a partial duplication of the urethra and a single h ypospadiac penis. After separation, each had kidneys draining into a b ladder, one received the urethra and external genitalia, and one a uro stomy. Conclusion Complex urological problems occur in conjoined twins , although restricted to those with pelvic fusion (ischiopagus). Asses sment and treatment needs to be individualised and overseen by a surge on with experience in complex urology.