Duplex system

There are varying degrees of duplication of the urinary tract, some of which are inconsequential, for example partial bifid ureter. In accordance to embryology, the lower pole ureter generally inserts more lateral and cephalad into the bladder than the upper pole ureter which has a more medial and caudal orifice that is sometimes ectopic. As a consequence, the lower pole ureter is more prone to reflux, whereas the upper pole ureter is more often obstructed (Weigert-Meyer law). The commonest entity requiring treatment consists of a poorly functioning upper kidney moiety drained by an ectopic ureter. The ureter may open into a ureterocele in the bladder, or rarely outside the bladder in which case the child typically wets in between normal voids. Urinary infection is more commonly the presenting symptom. Treatment consists of upper pole nephroureterectomy. Associated anomalies, for example ureterocele, may require additional procedures.

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