28 Journal of Progress in Paediatric Urology, Jan-Apr 2014, Vol 17, Issue 1 Original Article Pelviureteric Junction Obstruction in Duplex System: Management and Review of Literature S. S. Panda, M. Bajpai, A. Singh,Col. K. Chand, N. Sharma Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India Abstract. Objective: Objective of this study was to review the management and outcome of 17 children with pelvi-ureteric junction obstruction (PUJO) in a duplex kidney. Materials and Methods: We analyzed our record from January 2000 to December 2011. A total of 258 pyeloplasty in a single system and 17 pyeloplasty in duplex system were performed during this period. Lower and upper pole moiety obstruction was seen in both complete and incomplete duplex systems. The duplex was suspected in ultrsonography (USG), renal scintigraphy and confirmed on magnetic resonance urography (MRU). Results: Ten children had upper moiety obstruction while seven had a lower moiety obstruction. Upper and lower pole obstructions were seen in both complete and incomplete duplex moiety. Eleven children underwent Anderson-Hynes pyeloplasty, three underwent ureteropyelostomy, and two underwent heminephrectomy while one underwent uretero-ureterostomy Conclusion: There are a multitude of surgical options to deal with PUJO in duplex system and management should be based on the pathological and functional anatomy and the experience of the surgeon. Keywords: Duplex system, Lower moiety, Pelviureteric junction obstruction, Upper moiety Received: 16 January 2014 / Accepted: 20 January 2014 Introduction Ureteral duplication is one of common anomalies affecting the genitourinary tract. Pelviureteric junction obstruction (PUJO) is the most common site of obstruction in the upper urinary system. PUJO in duplex system is an unusual entity and infrequently reported. Managing PUJO in duplex system is difficult for the treating surgeon. We are reporting our experience in managing PUJO in a duplex system with review of literature. Objective of this study was to review the management and outcome of cases with pelvi-ureteric junction obstruction (PUJO) in a duplex system. Materials and Methods We retrospectively analyzed our record from January 2000 to December 2011. The inclusion criteria were all cases of PUJO Copyright and reprint request: Dr. M. Bajpai, MS, MCh, PhD, FACS, FRCS, FAMS (India), DNB, Fulbright Scholar (USA), Commonwealth Fellow (UK), Raja Rammana Fellow (India) Professor, Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India.,Web: www.paediatric- urologyonline.org;E-mail: bajpai2@hotmail.com; Ph:+91-11- 26593555; Mob:+91-981-802-5584 in a duplex system and minimum postoperative follow up of 24 months. Exclusion criterias were incomplete data and presence of associated hypertension and other associated genitourinary anomalies. Diagnostic investigations included renal ultrasonography, renal scintigraphy, diethylenetriamine Penta-acetic acid (DTPA), dimercaptosuccinic acid (DMSA), and magnetic resonance urography (MRU). The duplex was suspected on USG and renal scintigraphy and was confirmed by MRU. We have preferred MRU over DTPA simply because it provided the best functional and anatomical information needed by the surgeon dealing with duplex system. DTPA was used for quantifying differential renal function because of cost and availability as compared to MAG 3. MRU was done using heavily T2-weighted images; contrast enhanced T1-weighted MR sequences and maximum intensity projection (MIP) after proper hydration in 1.5T MR scanner imaging. Patients were sedated with trichlorofos (pedicloryl) in the dose of 50 mg/ kg. Intravenous fluids were given as per body weight to maintain proper hydration. Intravenous gadolinium contrast was used for the study for image acquisition using abdominal or body coil, with patient in supine position and coil positioned over upper abdomen and centred on kidneys. After initial localizing images were obtained in the following