A duplex renal system is characterized by the duplication of the ureter, resulting in two ureters draining a single kidney, with a prevalence of 1-2%. Complications can include ureteroureteral reflux and ectopic ureter, requiring different management approaches based on the presence of symptoms. Diagnosing a duplex renal system typically involves ultrasound and may include additional imaging techniques to assess kidney function and structure.

2. DUPLEX RENAL SYSTEM
DR.JAWAD SAIFULLAH
PGR UROLOGY AND RENAL
TRANSPLANTATION
ALLIED HOSPITAL , FAISALABAD

3. LEARNING
OBJECTIVES:
2. Identify its
anatomical
features.
1. Define
duplex renal
system.
3. Recognize
potential
complications.
4. Learn how to
diagnose and
manage related
disorders.

4. WHAT IS A DUPLEX
RENAL SYSTEM:
A duplex renal system occurs when there is a
duplication of the ureter, resulting in two
ureters draining a single kidney.
The exact prevalence of this anomaly is
difficult to ascertain because most patients
are asymptomatic, and the abnormality is
frequently detected incidentally. Prevalence
1-2%.

5. EMBRYOLOGY
The ureteric bud grows towards the metanephric
blastema (nephrogenic cord), which later develops
into the nephrons of the kidney.
The collecting system of the kidney develops from
the ureteric bud, a small outgrowth from the
mesonephric duct (Wolffian duct) .
The interaction between the ureteric bud and the
metanephric blastema is crucial for the formation
of the collecting system.

8. INCOMPLETE DUPLEX URETER (BIFID URETER):
This anomaly develops when a single
ureteral bud branches before it
reaches the metanephric blastema.
01
02
• The duplicated ureters unite at a
variable distance from the kidney, and
only one ureteral orifice is present on
the affected side.

9. COMPLETE DUPLEX URETER:
In the case of complete duplication of the
ureter, a developmental abnormality occurs
where two ureteric buds arise from the
mesonephric duct instead of the normal single
bud.
This leads to the formation of two ureters
originating from a single kidney rather than
the typical single ureter.
01
02

10. COMPLICATIONS:
INCOMPLETE
DUPLEX
URETER:
Ureteroureteral
reflux, also known
as yo-yo, saddle,
or seesaw reflux,
is a common
phenomenon
This is commonly associated with
vesicoureteral reflux as a result of a
lack of sufficient submucosal tunnel
that leads to pyelonephritis,
scarring and a so-called “drooping
lily” appearance on IVPs

12. COMPLETE
DUPLICATION:
Ureters that arise from a position either
lower or higher than the normal position
are associated with ectopic insertions,
renal dysplasia, and related complications
Common complications of complete
duplication are vesicoureteral reflux,
ectopic ureterocele, ectopic ureteral
insertion, ureteropelvic junction
obstruction of the lower pole.

13. MOST COMMON OF
ECTOPIC URETERIC
ORIFICE:
Male : Orifice in prostatic urethra
and in proximal to external
urinary sphincter.
Female: Orifice of upper moiety
ureter is in urethra distal to urinary
sphincter.

14. INVESTIGATIONS
Ultrasound is often the first-line
imaging modality used to diagnose
a duplex renal system.
• Anatomical Assessment
• Complications Detection
• Monitoring
• Guidance for Procedures
Sonography:

15. INTRAVENOUS
UROGRAPHY:
• Evaluation of
the function of
each kidney
• Identifying
any structural
abnormalities
• Assessing the
drainage of
urine

16. • DTPA(Diethylenetriaminepentaacetic acid)
• CT Urography

17. MANAGEMENT:
With complications Without complications
No intervention
required
What are the
symptoms/complications?

18. COMPLICATIONS
AND TREATMENTS:
01
Urolithiasis:
URS , RIRS ,
PCNL,
ESWL ,pyelolitho
tomy,
ureterolithotomy
02
Reflux: Re-
implantation
of ureter.
03
Obstruction :
Pyeloplasty
04
Ectopic
ureter: Re-
implantation
05
Nonfunctionin
g kidney:
Nephrectomy,
partial
nephrectomy

19. THANK YOU