Long-term urological outcomes in six sets of conjoined twins.
AIM
To review the long-term urological outcomes of six sets of ischiopagus and pygopagus conjoined twins. Emphasis is placed on the particular genitourinary challenges of separation, reconstruction and monitoring of these patients.


PATIENTS AND METHODS
We performed a longitudinal, retrospective analysis of six sets of conjoined twins who presented to a single center and describe their long-term urological outcomes.


RESULTS
Six sets of ischiopagus (4) and pygopagus (2) conjoined twins presented from 1993 to 2003 and have been followed up for a mean of 12 years (range 7-17 years). Separation was achieved in 5/6 cases; the remaining one died of intestinal perforation and resultant sepsis. One further child died of malaria after separation. Patterns of genitourinary anatomy found in these conjoined twins are described. Urinary continence was achieved in 2/6 ischiopagus and 3/4 pygopagus twins. Renal failure has developed in one child. Urinary tract infections have been common. Secondary urological surgery has been required in 3/6 ischiopagus twins, usually to perform an incontinent urinary diversion.


CONCLUSION
Complex urological problems occur in ischiopagus and pygopagus conjoined twins. Beyond the challenge of surgical separation, they continue to provide management challenges requiring secondary reconstructive surgery and close urological monitoring.