Surgical management of incomplete duplex kidney with both upper and lower moieties ureteropelvic junction obstruction: a case report with modified reconstructive method

An incomplete duplex kidney combined with ureteropelvic junction obstruction is a rare entity, and the surgical management strategy is highly individualized according to the anatomic variability. Currently, there is no literature report of the specific reconstructive method for the condition when obstruction occurs in both the upper and lower units of the duplex kidney. In this case report, a 60-year-old female with a right solitary kidney was admitted to our hospital. The patient suffered intermittent right flank pain and had an occasionally palpable abdominal mass for seven years. Computed tomography and intravenous pyelography revealed an incomplete duplex kidney with obstruction in both the upper and lower units with a proximal confluence. A specially designed reconstructive method, including an ureteropyelostomy between the upper pole ureter and lower pole pelvis, plus a dismembered pyeloplasty between the lower pole pelvis and common ureter, was used, with no intra- or postoperative complications. The patient remained symptom free at the 6-month, 1-year and 2-year follow-ups. A diuretic renal scan showed better drainage, and ultrasound revealed no significant hydronephrosis. Thus, our specially modified reconstructive strategy could be a method of choice when addressing particular anatomies, such as incomplete duplex kidneys with ureteropelvic junction obstruction in both upper and lower poles when the obstruction is close to the confluence of the two ureters.