Complete Ureteral Duplication Research Articles

Fate of the Retained Ureteral Stump After Upper Pole Heminephrectomy in Duplex Kidneys

No AccessJournal of UrologyPEDIATRIC UROLOGY: Classic Article in Pediatric Urology1 Aug 2002Fate of the Retained Ureteral Stump After Upper Pole Heminephrectomy in Duplex Kidneys Diane De Caluwé, Boris Chertin, and Prem Puri Diane De CaluwéDiane De Caluwé More articles by this author , Boris ChertinBoris Chertin More articles by this author , and Prem PuriPrem Puri More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64722-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We review the long-term outcome of retained ureteral stumps in children undergoing heminephrectomy for nonfunctioning upper pole moieties in duplex kidneys. Materials and Methods: The medical records of 50 patients who underwent 50 upper pole heminephrectomies for a nonfunctioning upper pole moiety of a duplex kidney between January 1990 and December 2000 were reviewed retrospectively. Results: Median patient age at heminephrectomy was 2.5 years (range 3 weeks to 16.5 years) and median followup was 6 years (range 1 to 11). Indications for heminephrectomy in the 50 renal units were obstructive ureterocele in 25 (50%) cases, ectopic ureter in 15 (30%), obstructive megaloureter in 5 (10%) and reflux nephropathy in 5 (10%). A total of 48 (96%) of the corresponding ureters were taken down as low as possible and transfixed through the heminephrectomy incision. Residual stump excision was required in 5 (10%) of the 50 units for recurrent urinary tract infection due to vesicoureteral reflux. Conclusions: Our long-term followup suggests that the majority of patients with residual ureteral stumps after upper pole heminephrectomy do not require stump resection. References 1 : Is there a best alternative to treating the obstructed upper pole?. J Urol1996; 156: 744. Link, Google Scholar 2 : A simplified technique of upper pole heminephrectomy for duplex kidney. J Urol2000; 164: 1326. Abstract, Google Scholar 3 : Ectopic ureter with complete ureteric duplication in the female child. J Pediatr Surg1992; 27: 1455. Google Scholar 4 : Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol1984; 132: 1153. Link, Google Scholar 5 : Ureteral duplication, ectopy, and ureteroceles. In: Pediatric Urology. Edited by . Philadelphia: W. B. Saunders Co.2001: 430. chapt. 28. Google Scholar 6 : Management of ectopic ureters: experience with the upper tract approach. J Urol1997; 158: 1245. Link, Google Scholar 7 : Ectopic ureter with complete ureteric duplication: conservative surgical management. J Pediatr Surg1996; 31: 467. Google Scholar 8 : Upper pole heminephrectomy: is complete ureterectomy necessary?. BJU Int2001; 88: 77. Google Scholar 9 : Natural history of refluxing distal ureteral stumps following tract surgery in children with ectopic ureter or ureterocele. Urol Int2001; 67: 142. Google Scholar 10 : Natural history of refluxing distal ureteral stumps after nephrectomy and partial ureterectomy for vesicoureteral reflux. J Urol1998; 160: 1026. Link, Google Scholar 11 : Ureterocele associated with ureteral duplication and a nonfunctioning upper pole segment: management by partial nephroureterectomy alone. J Urol1995; 154: 723. Link, Google Scholar From the Children’s Research Centre, Our Lady’s Hospital for Sick Children, Dublin, Ireland© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byLee Y, Hah Y, Kim M, Jung H, Lee M, Im Y and Han S (2012) Factors Associated with Complications of the Ureteral Stump After Proximal UreteroureterostomyJournal of Urology, VOL. 188, NO. 5, (1890-1894), Online publication date: 1-Nov-2012.Wallis M, Khoury A, Lorenzo A, Pippi-Salle J, Bägli D and Farhat W (2018) Outcome Analysis of Retroperitoneal Laparoscopic Heminephrectomy in ChildrenJournal of Urology, VOL. 175, NO. 6, (2277-2282), Online publication date: 1-Jun-2006.GUNDETI M, RANSLEY P, DUFFY P, CUCKOW P and WILCOX D (2018) RENAL OUTCOME FOLLOWING HEMINEPHRECTOMY FOR DUPLEX KIDNEYJournal of Urology, VOL. 173, NO. 5, (1743-1744), Online publication date: 1-May-2005.GRAN C, KROPP B, CHENG E and KROPP K (2018) PRIMARY LOWER URINARY TRACT RECONSTRUCTION FOR NONFUNCTIONING RENAL MOIETIES ASSOCIATED WITH OBSTRUCTING URETEROCELESJournal of Urology, VOL. 173, NO. 1, (198-201), Online publication date: 1-Jan-2005.DUBOSQ F, DOUBLET J, TRAXER O, HAAB F and AMARENCO G (2018) Incontinence From Ectopic Ureter: Retroperitoneal Laparoscopic Urovascular Exclusion of Upper PoleJournal of Urology, VOL. 171, NO. 2, (800-801), Online publication date: 1-Feb-2004. Volume 168Issue 2August 2002Page: 679-680 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsurinary tract infectionsnephrectomyvesico-ureteral refluxureterMetricsAuthor Information Diane De Caluwé More articles by this author Boris Chertin More articles by this author Prem Puri More articles by this author Expand All Advertisement PDF downloadLoading ...

Sotos syndrome associated with complete ureteral duplication and bilateral vesicoureteral reflux

A 4-year-old boy with Sotos syndrome had repeated urinary tract infections. Complete right ureteral duplication and bilateral vesicoureteral reflux were, diagnosed, and anti-reflux surgery was performed. This child also had elevated serum creatine kinase levels and atypical absence seizures. The associations of ureteral duplication, continuously elevated serum creatine kinase level, and atypical absence seizure have not been reported previously in Sotos syndrome.

ANASTOMOTIC CALCULUS FORMATION AFTER SIDE-TO-SIDE URETEROURETEROSTOMY IN A PATIENT WITH COMPLETE URETERAL DUPLICATION

Complete ureteral duplication, either unilateral or bilateral, occurs in approximately 1 of 334 individuals.1, 2 Hydronephrosis may occur with either moiety and is usually secondary to reflux into the lower pole moiety, while upper moiety obstruction is caused by urethral ectopia or a ureterocele. Surgical options for obstruction or reflux with complete ureteral duplication include common sheath reimplantation for functional renal segments and partial nephrectomy for nonfunctional segments. Ipsilateral end-to-side ureteroureterostomy is also an acceptable surgical modality in select patients. 3 We report on a patient who underwent ipsilateral ureteroureterostomy using a side-to-side anastomosis with subsequent calculus development at the anastomotic site. CASE REPORT

The management of children with complete ureteric duplication: selective use of uretero-ureterostomy as a primary and salvage procedure.

To determine the optimum management of duplex urinary tracts with refluxing or obstructed units. Sixty-three children (19 boys and 44 girls) with complete duplex-system anomalies (84 duplex system units) who underwent corrective surgery by one surgeon (H.C.) between March 1983 and June 1997 were reviewed, analysing their diagnosis and treatment. Most children had presented with urinary tract infection; a ureterocele was found in 26 renal units, reflux in 12 and a combined anomaly in 18. Ectopic insertion of the ureter causing incontinence was found in six and ureteric obstruction in nine ureteric units. Patients were managed so that whenever possible, functional renal tissue was preserved; thus surgical strategies were basically staged, conservative, and planned preoperatively on the basis of renal function. Initial surgery was undertaken in 71 units (all patients; ureterocele incision in 12, upper pole nephrectomy in 30, ureteric reimplantation in 14, uretero-ureterostomy in 13 and others in two). The median (range) follow-up was 7.6 (2.1-16) years. Secondary procedures were undertaken in 24 units (34%); ureterocele incision (11 of 12 units) was the most common procedure of additional surgery, followed by ureteric reimplantation (six of 27 units), upper pole nephrectomy (eight of 37 units) and uretero-ureterostomy (two of 18 units). Uretero-ureterostomy was the most successful nephron-sparing additional operation. When the upper pole is salvageable, uretero-ureterostomy may be the preferred alternative for managing complete duplex system anomalies.

Extensive surgery on the trigone for complete ureteral duplication does not cause incontinence or voiding problems

Objectives. To evaluate whether extensive trigonal surgery for duplicated kidneys is harmful for later bladder and urethral function. Methods. Of 201 surgically treated children with kidney and ureteral duplication, 145 were followed up for at least 1 year. The mean follow-up was 5 years (range 1 to 15), and all patients were at least 7 years old at the date of their last follow-up visit. Trigone surgery was performed in 105 children; bilateral trigonal surgery in 26, unroofing in 25, and total excision in 5. On all later consultations, the presence of infection, voiding habits, continence pattern, and ultrasound findings for residual urine volume and kidney function were noted. Children with recurrent urinary tract infection or dysfunctional voiding for more than 2 years underwent a urodynamic examination. Results. Nine children, of whom five were boys, had nocturnal enuresis only. Eight patients had day and nighttime wetting. Seven of the 8 patients had recurrent urinary infections; urodynamic evaluation revealed a high compliance (with residual urine) in three of these children and four had detrusor instability. One girl had an irregular bladder neck, with stress incontinence. All reflux, whether surgically or conservatively treated and also three of four occurring de novo, disappeared within 1 year after surgery. In the group without voiding dysfunctions, seven cystitis and five pyelonephritis attacks occurred. Conclusions. Neither extensive trigonal surgery nor pre-existing trigonal deformation by ureteroceles provokes later bladder dysfunction.

THE OUTCOME OF STOPPING PROPHYLACTIC ANTIBIOTICS IN OLDER CHILDREN WITH VESICOURETERAL REFLUX

Accepted management of vesicoureteral reflux includes surgical correction or prophylactic antibiotics with the hope for resolution as the child grows. The physician must consider surgery when reflux does not resolve despite uneventful years on prophylactic antibiotics. An alternative is cessation of the antibiotics. We report on the outcome of children taken off antibiotics with persistent reflux. During a 14-year period 51 children with documented reflux were taken off antibiotic prophylaxis. Selection criteria included children who were old enough to verbalize the symptoms of a urinary tract infection, and had normal voiding patterns, a minor history of infections and minimal or no renal scarring. Routine followup included nuclear cystography and renal sonography. A total of 40 girls and 11 boys maintained on antibiotics for a mean of 4.8 years were taken off prophylaxis and followed for an average of 3.7 years. Mean patient age when prophylactic antibiotics were stopped was 8.6 years. Reflux resolved in 10 children (19.6%). A urinary tract infection developed in 5 girls and 1 boy (11.8%) (mean age 11) an average of 2.3 years (range 4 months to 9.4 years) after antibiotic discontinuation. One child had symptoms consistent with cystitis and 5 had febrile urinary tract infections. All were treated with oral antibiotics and 5 had subsequent operations. No new renal scars developed. The majority of children did well following cessation of antibiotic prophylaxis despite persistent vesicoureteral reflux. Cessation of antibiotic prophylaxis is a reasonable option in a highly select patient population with reflux.

Surgical management of complete ureteric duplication abnormalities.

In 2 decades (1974-1993), the senior author (S.A.) managed 148 patients with various abnormalities associated with complete ureteric duplication. Included were 72 patients with primary vesicoureteric reflux, 50 with ureteroceles, and 26 with upper-pole ectopic ureters. The majority of the patients were female, and the common clinical presentations included urinary tract infection (UTI), UTI with septicemia, and urinary incontinence. Ten cases were diagnosed after recognition of a renal abnormality on prenatal ultrasonography, an avenue that has provided new challenges, new opportunities, and new dilemmas. This review article is based on the authors' experience together with an analysis of current emphasis on early diagnosis, minimal surgery, and maximum preservation of renal function.

Ipsilateral Pyeloureterostomy for Managing Lower Pole Reflux with Associated Ureteropelvic Junction Obstruction in Duplex Systems

In duplex renal systems with a normal upper pole collecting system, and a lower pole collecting system with reflux and ureteropelvic junction obstruction or a kink at the ureteropelvic junction (that is reflux with trapping), treatment must address reflux and obstruction. We reviewed the results of ipsilateral pyeloureterostomy as a single corrective procedure. We retrospectively reviewed our experience with 10 children who had complete ureteral duplication with lower pole reflux (grades III to V) and associated lower pole ureteropelvic junction obstruction or a ureteral kink with trapping. All patients were treated with ipsilateral end-to-side pyeloureterostomy. Followup ranged from 1 to 14 years. All patients had a good postoperative result, there have been no immediate or long-term complications and no subsequent surgical procedure was needed. All patients had continued lower pole renal growth with good function, 9 had resolution or a marked decrease in pelvicaliceal dilatation and none had evidence of obstruction. Ipsilateral end-to-side pyeloureterostomy for treating reflux into the lower moiety of a duplicated collecting system with associated ureteropelvic junction obstruction or a kink appears to be a single, safe corrective procedure that simultaneously manages vesicoureteral reflux and relieves the proximal obstructive process.

Ectopic ureter with complete ureteric duplication: Conservative surgical management

To assess the outcome of conservative procedures, the authors reviewed their experience in the management of 31 ectopic ureters with complete ureteric duplication. Twentyeight girls and three boys (aged 19 days to 10 years; mean, 30 months) were operated on between 1968 and 1994. Twentyfour of the children presented for evaluation of dribbling urinary incontinence and/or febrile urinary tract infections; seven presented after prenatal ultrasonographic diagnosis of hydronephrosis. The location of the ectopic orifice was identified in 25 children: bladder neck (6), posterior urethra (6), vagina (7), and vestibule (6). Upper pole nephroureterectomy was performed in 16 children who had nonfunctioning renal segments. Ureterovesical reimplantation was performed in 10 children who had functioning segments. In five borderline cases, temporary cutaneous ureterostomy was performed, followed by ureteropyelostomy (2), ureterovesical reimplantation (2), and upper pole nephrectomy (1). Histological examination of the polar nephrectomy specimens showed lesions of dysplasia in only four cases (24%). The follow-up period ranged from 6 months to 20 years (mean, 66 months). All children who presented with incontinence became continent after polar nephrectomy or conservative surgery. One child required surgical revision of the ureteropyelostomy anastomosis. Of the 12 children who had ureterovesical reimplantation, none needed further procedures. Ectopic ureters in duplex systems with functioning renal segments should be conserved.

Complete duplication of the ureter with ureteropelvic junction obstruction of the lower pole of the kidney: imaging findings.

The purpose of our study was to identify the radiographic signs that aid in the diagnosis of obstruction of the ureteropelvic junction of the lower pole (or moiety) of the kidney in children with complete duplication of the ureter and to describe the imaging appearance of this unusual cause of lower-pole hydronephrosis. We reviewed the medical records and imaging studies of 16 children (11 boys and five girls) with complete ureteral duplication and ureteropelvic junction obstruction of the lower pole of the kidney over a 5-year period. standard criteria for determining urinary tract obstruction were used. Sonograms showed a lower-pole abnormality (hydronephrosis or cystic mass) in all 15 children who underwent sonography. Voiding cystourethrography, performed for all children, showed vesicoureteral reflux into the lower pole in addition to ureteropelvic junction obstruction in eight children (seven boys and one girl). For the other eight, the diagnosis of lower-pole ureteropelvic junction obstruction was made by excretory urography, at times complemented with diuretic renography or retrograde ureterography. Ureteropelvic junction obstruction of the lower pole of the kidney in children with complete duplication of the ureter should be a diagnostic consideration when there is dilatation of the lower moiety. Imaging changes parallel those of ureteropelvic junction obstruction in a nonduplicated system. This anomaly, unlike others seen in duplication, appears to be more common in boys than in girls.

The Irish paediatrics association and section of paediatrics, royal academy of medicine in Ireland

Since the initial experimental studies in pigs, treatment of vesicoureteral reflux (VUR)inehildrenby endoscopic subureteral injection of polytetrafluoroethylene paste has been used by several investigators with encouraging results. Thirty-seven children (32 girls, 5 boys) with VUR in duplex systems were treated endnscopieally by the senior author (PP) using subureteric Polytef O~ injection and followed up for 1 to 7 years. Thirty-one patients had unilateral refluxing duplex systems and six had bilateraIrefluxing duplex systems. Twenty-sevenrefluxing units had complete ureteral duplication and 16 had incomplete uretesal duplication. All refluxing units had higher grade VUR at least into one of the moieties of the duplex system; 74% of the refluxing duplex ureters having grade 1II VUR and 26% either grade 1V or grade V reflux. Reflux was corrected in 14 (87%) of the 16 ureters with incomplete ureteral duplication after a single injection of Polytet ~ paste and two ureters required two injections to correct VUR. Of the 27 refluxing units with complete ureteral duplication, reflux was corrected in 16 (59%) units after a single injection of Polytef~ paste. 3 (11%) duplex systems showed improvement to grade ] or II reflux after one injection and no further treatment was given. Eight (30%) units with complete ureteral duplication required two to four subureteric injections for the correction of VUR. 93% of refluxing units where reflux was corrected with one subureteric injection of PolytolX~t paste required less than 0.3ml of paste per unit to stop reflux. Thirty-six o f the 37 patients were discharged from the hospital on the day of the procedure. At follow-up micturating cystography 93% of duplex systems continue to show absence of reflux 1 to 7 years after endoscopic correction. There was no evidence of delayed appearance of vesicoureteral obstruction on sonography. No significant complications have been observed in our patients with the use of Teflon to correct reflux. This endoscopic day care procedure offers a simple ahemative in the treatment of refluxing duplex systems.

Endoscopie Correction of Vesico-Ureteric Reflux in Duplex Systems

Between May 1984 and April 1990, 37 children with vesico-ureteric reflux (VUR) in 43 duplex systems were treated by endoscopic subureteric Teflon injection (STING). There were 32 girls and 5 boys; the duplex systems were complete in 27 refluxing units and incomplete in 16 refluxing units. All patients had high-grade reflux. In incomplete duplicated systems, VUR was corrected in 14 (87.5%) after a single injection of polytef paste and 2 patients required 2 injections to correct VUR. Of the 27 refluxing units with complete ureteral duplication, reflux was corrected in 16 (59%) units after a single injection of polytef paste, and 3 (11%) units showed improvement of VUR to grade I or II after 1 injection; no further treatment was given. 7 units with complete ureteral duplication required 2-4 injections for correction of VUR. STING failed to correct VUR in 1 duplex system which required a re-implantation. In 93% of refluxing units where VUR was corrected by a single injection, the quantity of polytef paste used was less than 0.3 ml. 36 (97%) of patients were discharged home on the day of the procedure. All patients were followed up for 2-8 years. Of the corrected ureters, there were no recurrences in the incomplete duplicated ureters. 3 of the completely duplicated ureters showed recurrence of reflux at follow-up micturating cystography.(ABSTRACT TRUNCATED AT 250 WORDS)

Ectopic ureter with complete ureteric duplication in the female child

Twenty-two female children with complete ureteric duplication and ectopic ureter (two bilateral) were seen in a 15-year period. The most common clinical presentation was dribbling urinary incontinence with “normal” micturition. Other presentations included urinary infection and vaginal discharge. Four cases were diagnosed after antenatal recognition of ureterohydronephrosis. The clinical diagnosis was supported by various radiological investigations but ultrasonography (US) proved to be particularly reliable in diagnosing ectopic ureter. The most common sites of opening of the ectopic ureter were the urethral margin or the urethrovaginal septum, although in seven cases the site was not identified. Twenty-one kidneys were managed by upper pole heminephrectomy and three by ureteropyelostomy, removing as much of the ectopic ureter as possible via the renal approach. The distal ectopic ureter was removed via a separate suprapublic incision at the initial operation in four cases, and in two cases, delayed excision of the distal ectopic ureter was necessary. All surgical specimens were examined histologically and only two heminephrectomy specimens showed features of renal dysplasia. Dribbling urinary incontinence was cured in all cases, although in one patient the entire kidney was lost after heminephrectomy. Ectopic ureter should be suspected in girls with dribbling urinary incontinence. The diagnosis is best supported by US together with conventional radiology. The majority of cases can be managed by heminephrectomy, but when adequate function is demonstrated in the upper pole, ureteropyelostomy is recommended.

Nonsurgical management of primary vesicoureteral reflux in complete ureteral duplication: Is it justified? : D.S. Peppas, S.J. Skoog, D.A. Canning, et al. J Urol 146:1594–1595, (December), 1991

Nonsurgical management of primary vesicoureteral reflux in complete ureteral duplication: Is it justified? : D.S. Peppas, S.J. Skoog, D.A. Canning, et al. J Urol 146:1594–1595, (December), 1991

Nonsurgical Management of Primary Vesicoureteral Reflux in Complete Ureteral Duplication: Is it Justified?

We reviewed the treatment of 56 children with vesicoureteral reflux and complete duplication of the collecting system, including 14 who had complete bilateral duplication. A total of 70 refluxing duplicated systems was analyzed. Of the patients 18% demonstrated spontaneous resolution of reflux within 42 months, 23% are currently stable on prophylactic antibiotics and 57.1% underwent surgical correction. Spontaneous resolution of reflux occurred in 58% of the children with grades I to III/V reflux. In comparing the group with reflux and duplication to a group with reflux into single systems, we conclude that the patients with duplication and lower grades of reflux can be managed nonoperatively, while infection is prevented with antibiotic prophylaxis.

Duplex Reflux: A Study of 105 Children

A series of 105 children with vesicoureteral reflux into completely duplicated collecting systems was studied retrospectively. Of the children 64% were treated surgically, with two-thirds undergoing an ablative procedure and one-third undergoing common sheath ureteral reimplantation. The remaining 36% of the children were managed nonoperatively and followed for up to 11 years. Among these cases 89% of the kidneys had reflux into the lower pole moiety only and 11% had reflux into the upper and lower pole moieties. The spontaneous rates of reflux resolution were 85% for grades I and II, and 36% for grade III reflux during a median observation period of 40 months. These figures suggest that the spontaneous resolution of mild to moderate reflux into completely duplicated collecting systems is similar to that of identical degrees of single system reflux during a comparable observational period.

Ureteroscopic Removal of Ureteral Calculi in Bilateral Ureteral Duplications

Two rare cases of ureteroscopic removal of impacted ureteral calculi in patients with partial and complete ureteral duplication are described. The procedural steps and problems encountered are discussed. Successful ureteroscopic stone extraction was obtained in the 2 patients.

Limitations and alternatives to endoscopic correction of vesicoureteral reflux with Polytef paste

Despite increased use with encouraging success rates, endoscopic correction of vesicoureteral reflux in children has persistent limitations. While many patients may be managed with this technique, a few with complete ureteral duplication or paraureteral diverticulum will not be successfully corrected. Nevertheless, precise placement of the implant beneath the ureteral orifice has resulted in success even in patients with highgrade reflux, patients with neuropathic bladder and in patients who have failed previous ureteroneocystostomy. Concern remains regarding the safety of the injectable Teflon substance, which elicits a local and distant foreign-body granuloma response. This has been noted in animal models and in a few human patients. Alternative substances such as glutaraldehyde cross-linked collagen and transplanted autologous fat may eliminate concern regarding the safety of the implant while preserving the excellent results reported with injectable Teflon.

Vesicoureteral Reflux in Complete Ureteral Duplication: Surgical Options

Vesicoureteral reflux is the most common abnormality seen with complete ureteral duplication. The majority of cases require surgical correction. The techniques used in 62 patients with 71 duplicated systems with reflux are reviewed.Reflux into the lower pole was encountered in 51 duplicated systems, both poles in 19 systems and the upper pole in 1. A total of 42 conjoint ureteral reimplantations was performed but in 8 cases only the lower pole ureter with reflux was reimplanted after it was separated from the nonrefluxing ureter. Ipsilateral ureteroureterostomy was performed in 19 cases of lower pole reflux. Two patients underwent lower pole heminephrectomy. Satisfactory results were obtained by all 3 reconstructive techniques. However, for lower pole reflux we recommend ipsilateral ureteroureterostomy unless a contralateral operation also is necessary. Ureteroureterostomy proved to be a simple and safe operation free of complications, with little morbidity and requiring a shorter hospitalization. (J. Urol, part 2, 140:1092-1094, 1988)

Campylobacter Urinary Tract Infection. Value of the Urine Gram’s Stain

CAMPYLOBACTER jejuni is a microaerophilic, curved to spiral, gram-negative bacillus. A frequent cause of bacterial diarrhea, C jejuni also causes extraintestinal infections that include sepsis, meningitis, pneumonia, cholecystitis, peritonitis, and prostatitis. 1-3 We report a case of C jejuni urinary tract infection (UTI). Report of a Case A 6-year-old girl presented to the Hartford (Conn) Hospital pediatric ambulatory care center with a threeday history of urinary frequency and incontinence. Her urine was described as cloudy and foul smelling. She had had no episodes of diarrhea. Her medical history was significant for multiple symptomatic UTIs that began at 15 months of age. At that time, radiologic studies showed a complete ureteral duplication on the right and bilateral vesicoureteral reflux. At 4 years of age, she underwent bilateral ureteral reimplantations. After surgery, she was asymptomatic until the present episode. On physical examination, she was afebrile and appeared well. She had neither costovertebral