Bilateral complete duplex system with non-functioning upper moieties and gross hydronephrosis with bilateral intravesical ureteroceles.

Introduction and importance: Duplex renal system is a congenital anomaly where the kidney has two separate ureters. While often asymptomatic, complications such as ureteroceles and hydronephrosis can arise, especially when associated with non-functioning upper moieties. Early diagnosis and intervention are essential to prevent long-term damage. Case presentation: A 3-year-old boy presented with fever and was diagnosed with a bilateral complete duplex renal system, non-functioning upper moieties, gross hydronephrosis, and bilateral intravesical ureteroceles based on an imaging study. Initial imaging with ultrasound and multidetector computed tomography revealed significant renal enlargement and ureteral dilation. A dimercaptosuccinic acid renal scan confirmed negligible function in the upper moieties. Surgical intervention involved holmium YAG laser incision of the ureteroceles and drainage of turbid fluid. Postoperatively, the patient showed no urinary retention and was discharged with antibiotics and antispasmodics. Follow-up confirmed normal urination and good overall health. Clinical discussion: Duplex renal systems, particularly with complications like ureteroceles and hydronephrosis, can significantly impact renal function if untreated. This case highlights the utility of advanced imaging techniques in diagnosing renal anomalies and the effectiveness of laser-assisted surgery in managing ureteroceles. Prompt surgical intervention in this case likely prevented further renal deterioration and restored normal urinary function. Conclusion: This case emphasizes the importance of early detection and intervention in congenital renal anomalies. The successful outcome in this child reinforces the value of timely surgical management to prevent complications and preserve renal function.