The upper pole ureter of a duplication anomaly can be orthotopic or associated with an ectopic insertion, a ureterocele, or even ureteropelvic junction obstruction. The lower pole ureter may terminate orthotopically or laterally on the trigone, resulting in varying grades of vesicoureteral reflux. It can also be associated with lower pole ureteropelvic junction obstruction. In this report, we describe 3 patients with ureteral duplication anomalies in whom both upper and lower ureters terminate ectopically outside the bladder. The mode of presentation, the diagnosis, and the management of this rare anomaly are described. In addition, a hypothesis is advanced to help understand the embryologic pathophysiology.
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