Complete renal duplication with lower pole obstructive ectopic ureter - An exception of the Weigert-Meyer rule

Duplex urinary systems with complete ureteral duplication typically follow the Weigert-Meyer rule, where the upper pole ureter is obstructive, and the lower pole ureter has vesicoureteral reflux. We report a rare lower pole obstruction caused by an ectopic ureter, deviating from this pattern. A 2-week-old male presented with lethargy, and fever. Imaging confirmed urosepsis from Klebsiella with severe right lower pole hydroureteronephrosis. The retrograde pyelogram revealed a duplicated system with an ectopic lower pole ureter. Initial management included ureterostomy, followed by heminephrectomy and ureterectomy due to non-functionality. The patient recovered well. Individualized management is crucial in rare duplex anomalies.