Unusual ureteric duplication abnormality in a child with pelvoureteric junction obstruction

A 5-year-old girl underwent an elective left pyeloplasty for pelvoureteric junction obstruction (PUJO). At laparoscopy, two ureters were seen to be draining a left duplex kidney, with a PUJO of the lower moiety. Interestingly, however, the upper moiety ureter was bifurcating to drain both upper and lower moiety as well. All the preoperative investigations were suggestive of a single system. The ureteric bifurcation of this type has not been reported so far. It is of paramount importance to demonstrate anatomy clearly at an operation to prevent risk to the less defined ureters.