Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

This 3-year-old girl had an afebrile urinary tract infection. VCUG showed reflux into the upper pole of the left duplex kidney (Figure 1). The ureter seemed to end in a ureterocele and it was thought that this was the sphincteric variety. An IVP (Figure 2A, 2B) showed a normal right duplex kidney and confirmed that there was a left duplex kidney with upper pole hydroureteronephrosis and good function. The ureter seemed to end in a ureterocele. There was mild fullness of the lower pole pelvicalyceal system due to crossing of the lower UPJ by the dilated upper pole ureter. Ultrasonography seemed to confirm that it was a ureterocele in the bladder (Figure 3).

At the time of surgery, it was seen that this was not a ureterocele (intravesical) but that it was an upper pole urethral refluxing ectopic ureter and the entire ureter was extravesical. She underwent excision of the distral ureter and common-sheath reimplantation.