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

History: Five-year-old girl with continuous urinary dribbling. Had febrile UTI at 2 1/2 years of age, before toilet training, and it was not realized at that time that she was always wet. VCUG normal. Ultrasound read as normal left and normal right duplex kidney.

Now, it is obvious that she is continuously wet. An ultrasound study again showed a normal right duplex kidney and a normal left kidney. An IVP showed a normal left single system kidney. On the right, there was a duplex kidney with poorly functioning nondilated upper pole (arrow, Fig-1) Contrast material was seen in the vagina and on the perineum on prevoiding images (arrow, Fig-2)

Physical exam showed an ectopic right upper pole ureteral orifice just below and just to the right of the urethral meatus. She is to undergo right upper pole nephroureterectomy.

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