Duplication of the upper urinary tract.

The possibility of ureteric duplication should always be considered in children presenting with urinary infection. A high degree of suspicion should be present during X-ray investigation. Surgery is nearly always required to cure the problem, vesicoureteric reflux requiring reimplantation and a ureterocoele involving both uncapping and reimplantation techniques. Heminephroureterectomy is rarely required except in cases of bizarre ectopic opening in which incontinence is the presenting feature and the associated renal segment is dysplastic. Ureteropyelostomy is required for the rare situation of saddle reflux in the bifid ureter of incomplete duplication. It is occasionally employed for complete duplication, but it must be stressed that the primary defect is always at the lower end of the ureter and such bypass surgery must be combined with a ureterectomy and, when necessary, reimplantation of the remaining ureters.