Incomplete Ureteral Duplication (UTI/VUR)

harn_19a_n.jpg: IVU of a boy at schoolage with repeated UTI and ambiguous abdominal pain. On the right side both ureters are dilated above the merging of both ureters into the common part. The ureter of the lower pole is more dilated. harn_19b_n.jpg: Operative findings in the same patient; dilated renal pelvis and ureter of the lower pole or renal part; the ureter of the upper renal part marked with a thread is also dilated; it has already been removed from the merging point. harn_19c_n.jpg: IVU of the same patient 6 months after resection of the ureter of the upper pole and pyelopyelic anastomosis between the two pelves. Normalized pyelocaliceal system of the right kidney with one single ureter, the lumen of which exhibits a localized residual dilatation. harn_19a_n.jpg to harn_19c_n.jpg: The diagnosis is a Y-type of incomplete duplication of the right ureter with a pendulum reflux, abdominal pain, and recurrent UTI. In pendulum reflux contrast or urine flows to and fro between the two ureters, and only a small amount of urine sometimes enters the common part of the ureter, and the bladder (ureteroureteral reflux or Yo-Yo phenomenon). The symptoms and signs can be explained by this pathological mechanism. In this case the upper ureter was resected and the upper pelvis was anastomosed with the lower pelvis. Postoperatively the boy was free of symptoms with a normalization of the upper urinary tract of the right kidney.