Double The Trouble

Abstract Introduction: Bilateral cases of Duplex Kidneys and Ureters with Complete duplication are exceedingly rare. Herein, we report a rare case of Bilateral Complete Duplex Kidney and Ureter with Hydronephrotic right upper moiety complicated by ureteric stone and stricture in an adult male, managed successfully. Case Capsule: A 44-year-old male patient with history of flank pain, fever, vomiting, raised creatinine and a complex past history of multiple interventions for Urolithiasis including ESWL, PCNL and RIRS, was diagnosed with Bilateral Complete Duplex system with gross hydronephrosis of right upper moiety, distal ureteric calculus in it and multiple right renal calculi on CT. Intraoperatively on Ureterorenoscopy revealed right upper moiety 5mm distal ureteric stone and stricture at L5 level. Stone fragmented with laser, with difficulty 5/24 DJ stent negotiated across the stricture. Patient’s condition dint improved even after a month and was posted for definitive surgery. Right upper moiety Ureterorenoscopy and RGP revealed stricture at L3-L4 level. Right PCNL done revealed turbidity in the system and three 10mm lower calyceal calculi retrieved. Open Right side to side Uretero-Ureterostomy done of upper and lower moiety segments over 6/26 DJ stent for unhealthy, fibrosed, 3cm right upper moiety ureteric stricture at L3-L4 level. Surgery was uneventful. Right DJ stent removed after 6 weeks. Conclusion: This article demonstrates a very rare incidence of Bilateral Complete Duplex system with ureteric stone and stricture in one moiety system that posed a surgical challenge. Thus double the problems of stones and stricture in double the systems caused actual trouble and was managed successfully.