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Ultrasound
Diagnosis
Urinary Tract
Normal Variants and Pseudolesions
Ureteral Duplication
Ureteral Duplication
Jane S. Kim, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Ureteropelvic duplication, duplicated kidney, duplex or bifid collecting system

              • Definitions

                • Presence of 2 separate pelvicalyceal collecting systems draining 1 kidney, which may join above bladder (partial/incomplete/bifid), drain into bladder separately (complete), or beyond bladder

              IMAGING

              • General Features

                • Ultrasonographic Findings

                  • Fluoroscopic Findings

                    • Nuclear Medicine Findings

                      • Radiographic Findings

                        • CT Findings

                          • MR Findings

                            • Imaging Recommendations

                              DIFFERENTIAL DIAGNOSIS

                                PATHOLOGY

                                • General Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Calle-Toro JS et al: Morphologic and functional evaluation of duplicated renal collecting systems with MR urography: a descriptive analysis. Clin Imaging. 57:69-76, 2019
                                              2. Didier RA et al: The duplicated collecting system of the urinary tract: embryology, imaging appearances and clinical considerations. Pediatr Radiol. 47(11):1526-38, 2017
                                              3. Duran C et al: Contrast-enhanced voiding urosonography for vesicoureteral reflux diagnosis in children. Radiographics. 37(6):1854-69, 2017
                                              4. Adeb M et al: Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am. 21(4):717-30, 2013
                                              5. Lipson JA et al: Subtle renal duplication as an unrecognized cause of childhood incontinence: diagnosis by magnetic resonance urography. J Pediatr Urol. 4(5):398-400, 2008
                                              6. Wah TM et al: Lower moiety pelvic-ureteric junction obstruction (PUJO) of the duplex kidney presenting with pyonephrosis in adults. Br J Radiol. 76(912):909-12, 2003
                                              7. Callahan MJ: The drooping lily sign. Radiology. 219(1):226-8, 2001
                                              8. Zissin R et al: Renal duplication with associated complications in adults: CT findings in 26 cases. Clin Radiol. 56(1):58-63, 2001
                                              9. Fernbach SK et al: Ureteral duplication and its complications. Radiographics. 17(1):109-27, 1997
                                              10. Ulchaker J et al: The spectrum of ureteropelvic junction obstructions occurring in duplicated collecting systems. J Pediatr Surg. 31(9):1221-4, 1996
                                              11. Bellah RD et al: Ureterocele eversion with vesicoureteral reflux in duplex kidneys: findings at voiding cystourethrography. AJR Am J Roentgenol. 165(2):409-13, 1995
                                              12. Fernbach SK et al: Complete duplication of the ureter with ureteropelvic junction obstruction of the lower pole of the kidney: imaging findings. AJR Am J Roentgenol. 164(3):701-4, 1995
                                              13. Husmann DA et al: Ureterocele associated with ureteral duplication and a nonfunctioning upper pole segment: management by partial nephroureterectomy alone. J Urol. 154(2 Pt 2):723-6, 1995
                                              14. Share JC et al: The unsuspected double collecting system on imaging studies and at cystoscopy. AJR Am J Roentgenol. 155(3):561-4, 1990
                                              15. Winters WD et al: Importance of prenatal detection of hydronephrosis of the upper pole. AJR Am J Roentgenol. 155(1):125-9, 1990
                                              16. Share JC et al: Ectopic ureterocele without ureteral and calyceal dilatation (ureterocele disproportion): findings on urography and sonography. AJR Am J Roentgenol. 152(3):567-71, 1989
                                              17. Ahmed S et al: Vesicoureteral reflux in complete ureteral duplication: surgical options. J Urol. 140(5 Pt 2):1092-4, 1988
                                              18. Bisset GS 3rd et al: The duplex collecting system in girls with urinary tract infection: prevalence and significance. AJR Am J Roentgenol. 148(3):497-500, 1987
                                              19. Mesrobian HG: Ureteropelvic junction obstruction of the upper pole moiety in complete ureteral duplication. J Urol. 136(2):452-3, 1986
                                              20. Nussbaum AR et al: Ectopic ureter and ureterocele: their varied sonographic manifestations. Radiology. 159(1):227-35, 1986
                                              21. Amis ES Jr et al: Lower moiety hydronephrosis in duplicated kidneys. Urology. 26(1):82-8, 1985
                                              22. Gartell PC et al: Renal dysplasia and duplex kidneys. Eur Urol. 9(2):65-8, 1983
                                              23. Inamoto K et al: Duplication of the renal pelvis and ureter: associated anomalies and pathological conditions. Radiat Med. 1(1):55-64, 1983
                                              24. Gates GF: Ultrasonography of the urinary tract in children. Urol Clin North Am. 7(2):215-22, 1980
                                              25. Rose JS et al: Ultrasound diagnosis of ectopic ureterocele. Pediatr Radiol. 8(1):17-20, 1979
                                              26. Mascatello VJ et al: Ultrasonic evaluation of the obstructed duplex kidney. AJR Am J Roentgenol. 129(1):113-20, 1977
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Ureteropelvic duplication, duplicated kidney, duplex or bifid collecting system

                                                          • Definitions

                                                            • Presence of 2 separate pelvicalyceal collecting systems draining 1 kidney, which may join above bladder (partial/incomplete/bifid), drain into bladder separately (complete), or beyond bladder

                                                          IMAGING

                                                          • General Features

                                                            • Ultrasonographic Findings

                                                              • Fluoroscopic Findings

                                                                • Nuclear Medicine Findings

                                                                  • Radiographic Findings

                                                                    • CT Findings

                                                                      • MR Findings

                                                                        • Imaging Recommendations

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Calle-Toro JS et al: Morphologic and functional evaluation of duplicated renal collecting systems with MR urography: a descriptive analysis. Clin Imaging. 57:69-76, 2019
                                                                                          2. Didier RA et al: The duplicated collecting system of the urinary tract: embryology, imaging appearances and clinical considerations. Pediatr Radiol. 47(11):1526-38, 2017
                                                                                          3. Duran C et al: Contrast-enhanced voiding urosonography for vesicoureteral reflux diagnosis in children. Radiographics. 37(6):1854-69, 2017
                                                                                          4. Adeb M et al: Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am. 21(4):717-30, 2013
                                                                                          5. Lipson JA et al: Subtle renal duplication as an unrecognized cause of childhood incontinence: diagnosis by magnetic resonance urography. J Pediatr Urol. 4(5):398-400, 2008
                                                                                          6. Wah TM et al: Lower moiety pelvic-ureteric junction obstruction (PUJO) of the duplex kidney presenting with pyonephrosis in adults. Br J Radiol. 76(912):909-12, 2003
                                                                                          7. Callahan MJ: The drooping lily sign. Radiology. 219(1):226-8, 2001
                                                                                          8. Zissin R et al: Renal duplication with associated complications in adults: CT findings in 26 cases. Clin Radiol. 56(1):58-63, 2001
                                                                                          9. Fernbach SK et al: Ureteral duplication and its complications. Radiographics. 17(1):109-27, 1997
                                                                                          10. Ulchaker J et al: The spectrum of ureteropelvic junction obstructions occurring in duplicated collecting systems. J Pediatr Surg. 31(9):1221-4, 1996
                                                                                          11. Bellah RD et al: Ureterocele eversion with vesicoureteral reflux in duplex kidneys: findings at voiding cystourethrography. AJR Am J Roentgenol. 165(2):409-13, 1995
                                                                                          12. Fernbach SK et al: Complete duplication of the ureter with ureteropelvic junction obstruction of the lower pole of the kidney: imaging findings. AJR Am J Roentgenol. 164(3):701-4, 1995
                                                                                          13. Husmann DA et al: Ureterocele associated with ureteral duplication and a nonfunctioning upper pole segment: management by partial nephroureterectomy alone. J Urol. 154(2 Pt 2):723-6, 1995
                                                                                          14. Share JC et al: The unsuspected double collecting system on imaging studies and at cystoscopy. AJR Am J Roentgenol. 155(3):561-4, 1990
                                                                                          15. Winters WD et al: Importance of prenatal detection of hydronephrosis of the upper pole. AJR Am J Roentgenol. 155(1):125-9, 1990
                                                                                          16. Share JC et al: Ectopic ureterocele without ureteral and calyceal dilatation (ureterocele disproportion): findings on urography and sonography. AJR Am J Roentgenol. 152(3):567-71, 1989
                                                                                          17. Ahmed S et al: Vesicoureteral reflux in complete ureteral duplication: surgical options. J Urol. 140(5 Pt 2):1092-4, 1988
                                                                                          18. Bisset GS 3rd et al: The duplex collecting system in girls with urinary tract infection: prevalence and significance. AJR Am J Roentgenol. 148(3):497-500, 1987
                                                                                          19. Mesrobian HG: Ureteropelvic junction obstruction of the upper pole moiety in complete ureteral duplication. J Urol. 136(2):452-3, 1986
                                                                                          20. Nussbaum AR et al: Ectopic ureter and ureterocele: their varied sonographic manifestations. Radiology. 159(1):227-35, 1986
                                                                                          21. Amis ES Jr et al: Lower moiety hydronephrosis in duplicated kidneys. Urology. 26(1):82-8, 1985
                                                                                          22. Gartell PC et al: Renal dysplasia and duplex kidneys. Eur Urol. 9(2):65-8, 1983
                                                                                          23. Inamoto K et al: Duplication of the renal pelvis and ureter: associated anomalies and pathological conditions. Radiat Med. 1(1):55-64, 1983
                                                                                          24. Gates GF: Ultrasonography of the urinary tract in children. Urol Clin North Am. 7(2):215-22, 1980
                                                                                          25. Rose JS et al: Ultrasound diagnosis of ectopic ureterocele. Pediatr Radiol. 8(1):17-20, 1979
                                                                                          26. Mascatello VJ et al: Ultrasonic evaluation of the obstructed duplex kidney. AJR Am J Roentgenol. 129(1):113-20, 1977