Ureteral Duplication

Each kidney normally has one tube, called a ureter, that allows urine to be transported to the bladder. With ureteral duplication, a child is born with two ureters coming from the same kidney.

Some children with this abnormality have two entirely separate ureters coming from the same kidney (complete duplication). Others have two ureters that join together again before they get to the bladder (incomplete duplication).

Generally, no treatment is necessary unless there are issues with urination or kidney problems.

If the duplicated ureters are still allowing urine to flow from the kidneys to the bladder, children typically do not experience any symptoms. When urine flow is affected, a child may develop vesicoureteral reflux (VUR), a reversal of urine back to the affected kidney. This sometimes happens if one of the duplicated ureters has a weak valve. Occasionally, the one of the duplicated ureters may also be blocked or obstructed and may not drain well. In some instances, duplicated ureters drain somewhere other than the bladder (an ectopic ureter). If this happens, a child may have symptoms that include:

• Kidney swelling (hydronephrosis)
• Chronic urinary tract infections (UTIs)
• Incontinence

Ureteral duplication is usually detected during childhood, often when a child needs an image test for another problem affecting the pelvic area. Since issues related to duplicated ureters may mimic other urinary problems, a pediatric urologist may recommend testing that involves:

• A kidney/bladder ultrasound
• A voiding cystourethrogram performed with a special X-ray contrast material to track the flow of urine
• A CT scan or MRI performed often with a contrast material to better define the duplication, although these tests are performed more rarely

• When treatment becomes necessary because of issues related to a duplicated ureter, a pediatric urologist may suggest removal of part or all of a kidney (nephrectomy) that’s not working due to this abnormality.
• With a ureteroureterostomy, one of the duplicated ureters is split around and attached to the other ureter. This is done to the ureter that’s attached to the lower part of the kidney so that urine can flow normally from the upper portion of the affected kidney.
• If the main problem is urine leakage, ureteral reimplantation or ureteroureterostomy may be performed to split the affected ureter and attach it to the bladder or the non-leaking ureter.