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S15-3
(PP)
UROLOGICAL ANOMALIES, RECONSTRUCTION & CHALLLENGES ENCOUNTERED IN
CONJOINED TWINS SEPERATION.
Ahmad AL SHAMMARI
King Abdulaziz medical city -Riyad, Surgery-Urology Division, Riyadh, SAUDI ARABIA
PURPOSE
To review the spectrum of urogenital anomalies in conjoined twins and the urological procedures performed for
separation and reconstruction of urogenital tract.
MATERIAL AND METHODS
A retrospective review of 15 sets of conjoined twins with urogenital anomalies from January 1990 to March 2015.
RESULTS
Thirteen sets of complete conjoined twins and two set of parasitic twin were successfully separated. There was only one
death in an ischiopagus female set, as it underwent EXIT procedure soon after birth. There were 5 cases of
ISCHIOPAGUS TRIPUS twins, 5 ISCHIOPAGUS TETRAPUS, 3 PYOPAGUS TETRAPUS and 2 PARASITIC twins. Urogenital
reconstruction was carried out in 14 sets of twins at the time of separation, while was delayed in one set because of the
precarious condition of the surviving twin.
Urological anomalies in kidneys ranges from a twin set having only single functioning kidney each to malrotated ectopic,
duplex, dysplastic nonfunctioning kidneys, one horseshoe kidney to all four kidneys being horseshoe. The bladder
anomalies ranges from single commonly shared bladder to two separate bladders, two bladders in one twin to bladder
exstrophy. In females the internal genitalia varied from twins sharing single common vagina and uterus, fused vagina
and uterus, double vagina and uterus to complete duplication of whole internal genitalia. The external genitalia ranged
from completely separated two introitus to single fuse external genitalia. In males the internal genitalia ranges from
unilateral undescended testis to bilateral undescended to only one testis in twin set. The external genitalia ranged from
two sets of external genitalia to single set of external genitalia with two phalluses joined by skin to single fused phallus
with epispadiasis, to severe penoscortal hypospadiasis.
CONCLUSIONS
With extensive pre-operative planning and a multidisciplinary team approach, separation was feasible in all twins and
reconstruction aimed for renal conservations, urinary continence and functionally and cosmetically acceptable genitalia
can be safely achieved.