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Mostly the ectopic ureter belongs to the upper pole in urinary tract duplications. In the pelvis, the two ureters are clearly separated. The only dissection of the ectopic ureter is in no case dangerous for the ureter of the lower pole. Therefore the reimplantation of the ectopic ureter can be performed separately. This only reimplantation of the ectopic ureter has been performed 9 times, without any mortality nor morbidity. The scar is almost invisible and the child is cured without any risk for the upper pole and saving the whole of the renal parenchyma. If the upper pole is functional, which happened in 1/4 of the cases, this technique is the best way and the less dangerous to recovery.

Fourteen cases of obstruction after ureteroneocystostomy in children have been cured by surgery between 1972 and 1986; nine patients were referred from outside our hospital. This failure as been observed after reimplantation of simple thin ureter (29 cases) megaureter (7) or duplication (4). The diversity of lesions, of which 52 percent were ischemic stenosis, required surgery without any preconceived idea. A new reimplantation is often necessary, usually with Politano-Leadbetter procedure, and, if necessary, with a hitch-bladder. The operation is successful in 85 percent of patients, but the result is uncertain when the operation is late or when the value of renal parenchymal is initially poor.

Complicated pyelo-ureteral duplication in the adult may be revealed by recurrent pyelonephritis or urinary leakage. The diagnosis can be performed by combined urography and ultrasound scan. The management is rarely conservative. In most cases, it consists in hemonephrectomy. The ureterectomy is partial, extending up to the pelvic brim in the case of a fine ureter. If the ureter is dilated, however, the ureterectomy must be subtotal, in order to avoid postoperative infectious recurrence.