Duplication anomalies

Abstract Antenatal ultrasound has enabled early diagnosis of even minor duplication anomalies, and it is incumbent on the physician to decide when conservative management would be most appropriate. Some duplication anomalies are not diagnosed antenatally, and a high degree of suspicion is required to avoid delay in diagnosis. Decision-making is complex, and management of patients needs to be individualized with consideration for symptoms, function, and degree of dilatation. Ureterocele puncture is beneficial in acutely ill and symptomatic children, but there is a high risk of reflux and a need for secondary surgery. Definitive surgery for ectopic ureteroceles is complex, with a high risk of complications. Upper pole heminephroureterectomy is advantageous, as fewer than 10% of patients require ureterocele surgery subsequently—the risk is higher if there is high-grade reflux to the lower moiety. Low-grade reflux often resolves, but in high-grade reflux, spontaneous resolution and success with endoscopic injection are poor; therefore, common sheath reimplantation needs to be considered.