RENAL DUPLICATION

Two ureters on left side with seperation of both ureters till their insertion- s/o complete duplication on left side with no complications

·        Duplication may be either complete or incomplete and is often accompanied by various complications.

Incomplete duplication :  The duplicated ureters unite at a variable distance from the kidney, and only one ureteral orifice is present on the affected side.

·        Ureteroureteral reflux, also known as yo-yo, saddle, or seesaw reflux, is a common but transitory phenomenon .

·        Incomplete duplication is most often associated with ureteroureteral reflux or ureteropelvic junction obstruction of the lower pole of the kidney.

Complete duplication: The ureters are separated throughout their length with two separate orifices.

·        Weigert-Meyer rule: The ureter of lower moiety inserts into bladder at normal location, whereas the one of upper moiety inserts at a lower level ectopically in bladder or urethra or vagina.

·        Complete duplication is most often associated with vesicoureteral reflux, ectopic ureterocele, or ectopic ureteral insertion, all of which are more common in girls than in boys.

·        Vesicoureteral reflux affects the lower pole and can be outgrown, as in nonduplicated systems.

·        Ectopic ureterocele and ectopic ureteral insertion affect the upper pole.

·        The ectopic ureterocele produces a filling defect of variable size in the bladder; it can be identified with contrast material studies or ultrasound.

·        Ectopic ureters may function poorly, be difficult to detect, and cause enuresis in girls.

·        Ureteropelvic junction obstruction, occurs only in the lower pole and is seen in more boys than girls.

Reference: Ureteral duplication and its complications, Radiographics, 1997.