MINI REVIEW article
Front. Pediatr.
Sec. Pediatric Urology
Prophylactic Heminephrectomy for an Asymptomatic, Non-functioning Moiety in Pediatric Duplex Systems: Is Cancer Prevention Justified?
Provisionally accepted
- Kunming Children's Hospital, Kunming, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Duplication of the collecting system (DCS) is a common congenital anomaly, yet management of asymptomatic, non-functioning moieties remains controversial due to theoretical cancer risks. Prophylactic heminephrectomy is occasionally considered despite standard practice reserving surgery for symptomatic complications. Objective: To critically evaluate whether current evidence supports prophylactic heminephrectomy solely for cancer prevention in asymptomatic pediatric duplex systems. Methods: Mini review of PubMed/Embase literature (updated May 2025) and population cancer registries, focusing on absolute malignancy risk and DCS-specific oncologic evidence. Evidence Synthesis: Pediatric renal tumors are exceedingly rare (Wilms tumor: 7–10 per million children annually; pediatric RCC far rarer). The DCS-malignancy association rests entirely on six case reports (4 Wilms, 2 RCC) without any cohort studies demonstrating increased incidence above baseline. Biological plausibility for carcinogenesis in quiescent, uninfected moieties remains unproven. While minimally invasive heminephrectomy is relatively safe, perioperative morbidities (bleeding, urinary leak, stump complications, compromise of residual moiety) are non-negligible. Risk–Benefit Analysis: With no proven risk elevation and baseline malignancy incidence near zero, the oncologic benefit of prophylactic surgery is negligible compared to tangible surgical risks. Conclusions: Current evidence does not justify routine prophylactic heminephrectomy for asymptomatic, non-functioning moieties. A conservative strategy with structured ultrasound surveillance (6–12 month intervals) and clear surgical thresholds (febrile UTI/pyonephrosis, progressive obstruction, incontinence, calculi, enlarging mass) is prudent and evidence-aligned. Research Implications: Denominator-based, anatomically annotated registries are essential to quantify true malignancy risk and develop evidence-based guidelines.
Keywords: Duplex collecting system, Heminephrectomy, Prophylactic surgery, cancer prevention, Wilms Tumor, Clinical surveillance
Received: 10 Oct 2025; Accepted: 21 Nov 2025.
Copyright: © 2025 Zhanghuang and Yan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Chenghao Zhanghuang, 736564145@qq.com
Bing Yan, ybwcy@163.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.