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Objectives: Renal cell carcinoma (RCC) is a leading urological malignancy with an age-standardised incidence rate of 2.5 per 100,000 per year in Oman. Experts are inclined towards the early detection and use of minimally invasive technology for the treatment of RCC. This study aimed report the shifting trend in the clinical presentation and management of RCC in Oman, comparing the outcomes of laparoscopic and open nephrectomy. Methods: This retrospective study included adult RCC patients from Sultan Qaboos University Hospital, Muscat, Oman, diagnosed from 2011-2022. Patient biodata, mode of presentation, diagnostic modality, final histopathology and details of treatment received including the perioperative outcomes were analysed. Results: A total of 56 patients that underwent surgical treatment for RCC, 34 underwent laparoscopic nephrectomy (LN) and 22 underwent open nephrectomy (ON). The mean ages in the LN and ON groups were 53.82 ± 13.44 years and 56.22 ± 15.00 years (P = 0.53), respectively. There were 47 patients of Omani descent and 9 patients were expatiates. The patients' mean tumour size was 6.25 ± 3.16 cm and 9.23 ± 5.20 cm for the LN and ON groups, respectively; 55.35% of the RCC cases were incidentally diagnosed. A trend towards LN was observed. Conclusion: This study found a trend towards early diagnosis of RCC in Oman, with the majority of cancers being discovered incidentally in the studied period. LN is more commonly used in the surgical management of RCC with acceptable morbidity. These trends remain aligned with those found in the global literature on RCC.

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Objective: The aim of this study was to identify the risk factors for postoperative adverse events in children with duplex kidney undergoing upper pole heminephrectomy. Methods: We collected clinical data from pediatric patients with duplex kidney who underwent upper pole heminephrectomy. Based on the presence or absence of postoperative adverse events, the patients were divided into two groups: an adverse events group (n = 16) and a non- adverse events group (n = 37), using multivariate logistic regression analysis to screen for independent risk factors for postoperative adverse events. Results: Through univariate and multivariate analysis, we found that the presence of upper renal ureterocele (P = 0.042, OR = 7.116, 95% CI 1.073-47.172), as well as the presence of accessory renal artery type (P = 0.016, OR = 10.639, 95% CI 1.551-72.978) and other types (P = 0.039, OR = 3.644, 95% CI 0.351-37.836) as the upper kidney's blood supply artery increase the risk of postoperative adverse events, with these differences being statistically significant. Conclusions: In pediatric patients with duplex kidney undergoing upper pole heminephrectomy, the presence of upper renal ureterocele and the presence of accessory renal artery type and other types as the upper kidney's blood supply artery are independent risk factors for postoperative adverse events.

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Open and purely laparoscopic partial nephrectomy or heminephrectomy has been the standard management for renal duplication anomalies for symptomatic children with non-functional renal moieties. While robotic-assisted laparoscopic partial nephrectomy (RALPN) has been established as a safe and feasible option for the management of renal duplex anomalies, there remains a paucity of data on this topic. The aim of this study is to comprehensively review all available outcomes data and update the use of emerging technologies in robotic surgery which continue to make RALPN a viable and advantageous option in the management of renal duplex anomalies.

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INTRODUCTION: In this case report, we demonstrate our technique of a retroperitoneal laparoscopic heminephrectomy for a T1b right hilar tumor in a horseshoe kidney. CASE PRESENTATION: A 77-year-old Vietnamese woman presented to the hospital because of right flank pain. On presentation, her serum creatinine was 0.86 mg/dL and glomerular filtration rate was 65.2 mL/minute/1.73 m2. According to her renal scintigraphy, glomerular filtration rates of the right and left moieties were 24.2 and 35.5 mL/minute, respectively. Computed tomography imaging demonstrated a 5.5 × 5.0 cm solid hilar mass with a cT1bN0M0 tumor stage was in the right moiety. After discussion, the patient elected a minimally invasive surgery to treat her malignancy. The patient was placed in a flank position. We used Gaur's balloon technique to create the retroperitoneal working space, and four trocar ports were planned for operation. Three arteries were dissected, including two arteries feeding the right moiety, one artery feeding the isthmus, and one vein, which was clipped and divided by Hem-o-lok. The isthmusectomy was performed with an Endostapler. Consequently, the ureter was clipped and divided. Finally, the whole right segment of the horseshoe kidney was mobilized and taken out via the flank incision. RESULTS: The total operative time was 250 min with an estimated blood loss of 200 mL. The patient's serum creatinine after surgery was 1.08 mg/dL, and glomerular filtration rate was 49.47 mL/minute/1.73 m2. The patient was discharged on postoperative day #4 without complication. Final pathologic examination of the tumor specimen revealed a Fuhrman grade II clear cell renal cell carcinoma, capsular invasion, with negative surgical margins. After a three-month follow-up, the serum creatinine was 0.95 mg/dL, and glomerular filtration rate was 57.7 mL/minute/1.73 m2. Local recurrence or metastasis was not detected by follow-up computed tomography imaging. CONCLUSIONS: Retroperitoneal laparoscopic heminephrectomy is a safe and feasible technique for patients with renal cell carcinoma in a horseshoe kidney and may be particularly useful in low income settings without access to robotic technology.

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Background: Duplex kidneys may be associated with additional pathologies with an indication for surgery. Various surgical approaches have been described. However, little is known about long-term outcomes and quality of life (QoL) for these patients. Objective: To present long-term outcomes and QoL data up to 30 yr after surgical treatment of duplex kidneys and associated pathologies. Design setting and participants: We collected clinical and operative data for all patients who underwent surgery for complicated duplex kidney at our institution from 1990 to 2018. All patients were invited for a follow-up examination or telephone interview. Outcome measurements and statistical analysis: We evaluated renal function, clinical outcomes, residual dilation of the upper urinary tract, and health-related QoL. Results and limitations: Of the 176 patients included, 173 were available for follow-up (mean 140.5 mo). Surgical treatment involved an upper-tract, lower-tract, or combined approach in 11%, 56%, and 33% of cases, respectively. Rates of perioperative complications (8%) and secondary surgery (10%) were low. Overall, 95% of our patients achieved full restitution. Renal function was preserved in all cases, with recurrent urinary tract infections reported by just 2% and urinary incontinence by 1%. Good health-related QoL was reported by 98% of patients. Those without full restitution included six patients who underwent total nephrectomy and two boys who underwent multiple surgeries and urinary diversion. Our results are limited by their retrospective nature, including partly incomplete data sets. Conclusions: Management of duplex kidneys and associated pathologies is complex and highly individual. By planning a personal approach for each patient it is possible to achieve full bodily integrity and good QoL for most of these patients. Patient summary: Almost all patients undergoing surgery for duplex kidneys and associated pathologies will lead a life without body impairment and good quality of life.This trial is registered in the German Clinical Trials Register as DRKS00022542.

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INTRODUCTION: For children with duplex systems and severe hydroureteronephrosis of the upper pole, heminephrectomy is one of many suitable treatments, particularly if there is no associated lower pole reflux. Distal ureteral stump syndrome (DSS) is a very difficult complication and manifests as stump empyema, urinary tract infection and/or vulvar discharge and can occur months to years later in 10-20 percent of patients. Secondary distal ureterectomy is an extremely difficult surgery due to inflammation and adhesions. To avoid DSS, distal ureterectomy at the time of heminephrectomy can be performed concurrently but carries a risk of lower pole ureter devascularization and injury. Current literature on DSS has shown associations with subtotal ureterectomy or long ureteral stumps. We hypothesized that there may be preoperative variables prior to heminephrectomy that are associated with the development of DSS. OBJECTIVE: Identify pre-operative risk factors for the development of DSS in pediatric patients who underwent upper pole heminephrectomy for duplex kidneys. STUDY METHODS: Retrospective analysis of pediatric patients who underwent upper pole heminephrectomy at single, academic institution from 1999 to 2021. Pre-operative patient age, gender, history, imaging, and lab results were extracted from patient charts to assess for factors that may predict the development of DSS. Patient groups with and without DSS were compared using Fischer's Exact Test. RESULTS: Five (14%) of 36 patients developed DSS and required secondary distal ureterectomy at a median time of 22 months (IQR 6-27) after heminephrectomy. The presence of ureteral debris (80% of DSS) on preoperative ultrasound (p < 0.001), reflux into the upper pole (p = 0.005), and mucus discharge (100% of DSS) (p < 0.001) prior to surgery were found to be significantly associated with those who developed DSS, compared to those who did not. These three pre-operative factors had high specificity (97-100%) and negative predictive value (94-97%). DISCUSSION: Substantial experience has shown that less than 20% of patients benefit from distal ureterectomy during upper heminephrectomy. Whether using an open or laparoscopic approach, selection of at-risk patients should lower operative time and avoid injury and devascularization of the lower pole ureter for most patients. CONCLUSION: The presence or absence of ureteral debris, mucus discharge and/or upper pole reflux prior to heminephrectomy may be useful guides in selecting which patients would benefit from concurrent distal ureterectomy and conversely which patients may safely avoid the additional dissection.

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【Objective】 To analyze the differences in efficacy of heminephrectomy with robot-assisted laparoscopy (RARN) and laparoscopic radical nephrectomy (LRN). 【Methods】 The published references in national and international databases on the comparison of clinical outcomes between heminephrectomy RARN and LRN for kidney neoplasms were searched. References were screened strictly according to PICOS criteria, and data including estimated amount of blood loss, operation time, length of hospital stay and complications were extracted from those that met the requirements. Sensitivity analysis was used to eliminate the included articles one by one to confirm the robustness of the results, and funnel plot and Eggers test were used to explore publication bias. 【Results】 A total of 16 studies involving 2 063 patients (1 097 in RARN group and 966 in LRN group) were included. The RARN group had less intraoperative blood loss and shorter hospital stay, but there were no significant differences between the two methods (P>0.05). The incidence of postoperative complications in RARN group was lower than that in LRN group (OR: 0.643, 95%CI: 0.467-0.886, P=0.007). 【Conclusion】 Compared with LRN, RARN has better control of complications in the treatment of renal tumor, but the overall effects of intraoperative bleeding, operation time, and hospital stay are comparable.

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Introduction: and importance: Bilateral complete ureteral duplication is a rare urinary tract abnormality and presence of unilateral ectopic ureter makes it a rarest entity. Continuous urinary dribbling with normal voiding pattern and recurrent UTI are frequent presenting complains in case of ectopic ureter. Long term childhood problem of urinary incontinence with delayed diagnosis in adult in this case makes it a perfect case to report. Presentation of case: We present a case of 17-year-old girl with continuous urinary dribbling and constant wetting with normal voiding pattern since childhood. She also had recurrent history of urinary tract infections. Clinical findings and investigations: Local external examination of genitourinary system was found to be normal. There were skin lesions on buttocks and thighs suggestive of urine dermatitis. There were no examination findings of other congenital anomalies. Complete blood count, Renal function test, Serology, Urine R/ME, Urine culture and sensitivity, Ultrasound abdomen and pelvis, Computed Tomography scan, intraoperative cystoscopy were done. Intervention and outcome: Right upper pole hemi nephroureterectomy was performed. She was post operatively managed with IV Fluids, antibiotics, analgesics, antipyretics and antiemetics. She is asymptomatic now and regularly followed up on OPD basis. Relevance and impact: Congenital abnormalities of the genitourinary system like ectopic ureter should be clinically suspected in case of persistent urinary problems like urinary dribbling with normal voiding pattern and recurrent urinary tract infections. Upper pole heminephrectomy is an ideal choice of treatment in case of nonfunctional upper moiety. This case emphasizes the early detection of genitourinary abnormalities and provide the perspective on late diagnosis and management in such cases.

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INTRODUCTION: In this work, we present two cases of heminephrectomies with postoperative findings of cystic lesions in the bed of the excised renal segment. MATERIAL AND METHODS: Description of the clinical cases, therapeutic management and description of the ultrasound findings. A review of the published cases was carried out. RESULTS: We present a case of open heminephrectomy due to atrophy of the upper hemirrenal in a case of ureterocele, and another case with bilateral lower heminephrectomy in a case of vesicoureteral reflux disease. In the first case, the cystic lesion disappeared during follow-up, while in the second, the cysts remained stable. In none of the cases published in the literature was it necessary to perform any intervention to resolve the cysts. CONCLUSIONS: The appearance of cystic lesions in the heminephrectomy bed in pediatric patients is a radiological finding that occurs frequently. Due to its favorable evolution, without the need for additional procedures for its resolution, we do not consider the presence of these lesions as a complication after heminephrectomy.

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Introduction: In this work, we present two cases of heminephrectomies with postoperative findings of cystic lesions in the bed of the excised renal segment. Material and Methods: Description of the clinical cases, therapeutic management and description of the ultrasound findings. A review of the published cases was carried out. Results: We present a case of open heminephrectomy due to atrophy of the upper hemirrenal in a case of ureterocele, and another case with bilateral lower heminephrectomy in a case of vesicoureteral reflux disease. In the first case, the cystic lesion disappeared during follow-up, while in the second, the cysts remained stable. In none of the cases published in the literature was it necessary to perform any intervention to resolve the cysts. Conclusions: The appearance of cystic lesions in the heminephrectomy bed in pediatric patients is a radiological finding that occurs frequently. Due to its favorable evolution, without the need for additional procedures for its resolution, we do not consider the presence of these lesions as a complication after heminephrectomy (AU)

Objetivos: En este trabajo presentamos dos casos deheminefrectomías con hallazgos en el postoperatorio de lesiones quísticas en el lecho del segmento renal extirpado.Material y Métodos: Descripción de los casos clínicos, manejo terapéutico y descripción de los hallazgosecográficos. Se realizó una revisión de los casos publicados.Resultados: Presentamos un caso de heminefrectomía abierta por atrofia de hemirriñón superior en un casode ureterocele, y otro caso con heminefrectomía inferior bilateral en un caso de enfermedad por reflujo vesicoureteral.En el primer caso, la lesión quística desapareció duranteel seguimiento, mientras que en segundo, los quistes permanecieron estables. En ninguno de los casos publicadosen la literatura se precisó realizar ninguna intervención pararesolución de los quistes.Conclusiones: La aparición de lesiones quísticas enel lecho de la heminefrectomía en pacientes pediátricos esun hallazgo radiológico que sucede con frecuencia. Debidoa su evolución favorable, sin necesidad de procedimientosadicionales para su resolución, no consideramos la presencia de estas lesiones como una complicación tras la heminefrectomía. (AU)

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Duplex collecting systems are common congenital abnormalities of the urinary tract but are infrequently reported in adult populations. This abnormality can present with hydroureteronephrosis secondary to urinary tract obstruction or concomitant vesicoureteral reflux (VUR), recurrent urinary tract infections (UTIs), and urinary incontinence. Options for surgical management include common-sheath ureteral reimplantation, uretero-ureterostomy, pyelostomy, and heminephroureterectomy. We report the case of a 39-year-old female with a duplex kidney who presented with severe hydroureteronephrosis following a sacrocolpopexy.

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PURPOSE: To demonstrate the safety and feasibility of synchronous unilateral nephrectomy and contralateral heminephrectomy in extremely severe autosomal dominant polycystic kidney disease (ADPKD), which corresponds to the Mayo imaging classification classes 1D and 1E. MATERIALS AND METHODS: We retrospectively reviewed patients who underwent unilateral nephrectomy and contralateral heminephrectomy at the Seoul National University Hospital (Seoul, Korea) between May 1, 2016 and August 1, 2021. The preoperative kidney volume was calculated using the ellipsoid equation (length×width×thickness×π/6). The Mayo imaging classification was determined by height-adjusted total kidney volume and age. Using a midline vertical incision, heminephrectomy was performed first by horizontal transection, followed by contralateral nephrectomy. Hilar vessel clamping or resection-bed suturing was not required. RESULTS: In all, nine patients with ADPKD of the highest severity (Mayo class 1D/1E) underwent unilateral heminephrectomy and contralateral nephrectomy for the most common cause of severe abdominal discomfort and malnutrition. All nine patients had end-stage renal disease with hypertension and anemia. The median preoperative total kidney volume was 10,905.8 mL (interquartile range [IQR], 8,170.4-16,227.6 mL). The median operation time was 140 minutes (IQR, 125-185 min) and the median estimated blood loss was 250 mL (IQR, 200-425 mL). Eight of the nine patients were discharged without ICU care or any complications. Delayed pseudoaneurysm occurred in one case and was successfully managed by embolization. All patients were symptom-free for a median follow-up period of 2 years. CONCLUSIONS: Synchronous unilateral nephrectomy and contralateral heminephrectomy are safe and feasible treatment options for severe bilateral ADPKD.

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Duplex renal systems is a common anomalies. Incidence rate of 0.8% in healthy adult population and 2-4% in patients investigated for urinary tract symptoms. Urolithiasis management for patients with anomalies is complex and require proper imaging and planning. We have a patient with a partial duplex collecting system presented with a right renal calculus in a non-functioning lower moiety and multiple distal ureteric calculi. Preoperative planning done and surgery performed with good outcome without any early and late complications.

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Optimal management of duplication anomalies may include an upper or lower tract surgical approach. In the contemporary era, the robot-assisted laparoscopic heminephrectomy (RALHN) and robot-assisted laparoscopic ipsilateral ureteroureterostomy (RALIUU) are viable interventions predicated on clinical, institutional and surgeon preferences. We present a multi-institutional comparative analysis aiming to compare the outcomes of RALHN and RALIUU to see if either of the approaches confers an advantage over the other in treating duplex renal anomalies needing intervention. We completed a retrospective review of consecutive children undergoing RALIUU at Hospital A and RALHN at Hospital B from January 2009 to March 2017. The primary outcome was 'surgical success' defined by the resolution of clinical symptoms, improved radiological parameters, and no unplanned subsequent interventions till the time of study completion. Secondary outcomes included operative parameters, complications, and subsequent urinary infections. There were 39 RALIUU and 28 RALHN. Baseline demographic and clinical parameters across two cohorts were similar. The primary outcome of 'surgical success' was 100% across both cohorts. There were no major surgical complications, and the incidence of postoperative urinary tract infection was minimal and similar for both groups. Operative time favored RALHN; blood loss and analgesic requirements were minimal in both cohorts. Both RALIUU and RALHN are definitive surgical interventions in children with complex duplex moieties, delivering satisfactory surgical outcomes with a low complication profile and marginal differences in the postoperative patient outcomes. This pilot bi-institutional study provides the basis for a larger collaboration to further define optimal techniques, standardize surgical care pathways, and interrogate long-term outcomes.

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Resumen El manejo quirúrgico de los tumores renales pequeños es la cirugía conservadora de nefronas, este tipo de manejo se reservaba para pacientes seleccionados, con riñón solitario, enfermedad renal crónica o tumores bilaterales. La evidencia sugiere que la nefrectomía parcial laparoscópica es equivalente en términos de resultados oncológicos y superior en las mediciones de calidad de vida comparada al abordaje abierto. Objetivos: determinar los resultados oncológicos en cuanto a bordes libres del tumor y complicaciones quirúrgicas en pacientes sometidos a nefrectomía parcial y enucleación de tumor renal laparoscópico "Zero isquemia". Metodología: estudio retrospectivo, observacional, y comparativo, universo pacientes de la Clínica privada Los Ángeles y de la Caja Nacional de Salud, Hospital Obrero Nº2, Cochabamba, Bolivia, que fueron sometidos a nefrectomía parcial laparoscópica, se agruparon en dos grupos: Grupo I: nefrectomía parcial y Grupo II: enucleación, se analizaron: tamaño y localización del tumor, RENAL score, tiempo quirúrgico, sangrado, días de estancia, complicaciones y reporte histopatológico. Se utilizó el SPSS versión 20 (IBM, Chicago, IL). Resultados: se evaluaron 17 pacientes, 3 fueron excluidos por terminar en cirugía radical, 6 parciales (Grupo I) y 8 enucleaciones (Grupo II). Edad promedio de 45,7 (± 8,6) vs 51,2 (± 6,3) años. Tamaño del tumor 7,8 (2,5-10) vs 3,2 (1-5,7) cm, El RENAL score en global de todos los pacientes fue de baja a moderada, se realizó un análisis por separado, en el grupo I, la distribución fue complejidad baja n=2 (33,3%), moderada n= 1 (16,7%) y alta n= 3 (50%), en el grupo II, baja complejidad n=5 (62,5%), moderada n=2 (25%), alta complejidad n= 1 (12,5%). Hubo diferencias a favor del grupo II (enucleación) en cuanto a tiempo quirúrgico y sangrado transoperatorio, presentando solo 1 caso con fuga urinaria, resuelta con colocación de catéter JJ, se evidencia iguales tiempos de estancia intrahospitalaria, en cuanto a los bordes quirúrgicos, se tuvo 2 (14,2%) casos con bordes positivos 1 para cada abordaje, los cuales se mantienen en vigilancia estrecha. Conclusiones: el abordaje laparoscópico es una opción equiparable al abierto, se obtuvieron iguales resultados en cuanto a control oncológico en relación a bordes libres y con menos complicaciones, aunque se requiere experiencia en cirugía laparoscópica y aumentar el seguimiento en tiempo y mayor número de casos.

Abstract Surgical management of small renal tumors involves nephron-sparing surgery, which used to be reserved for selected patients with a solitary kidney, chronic kidney disease or bilateral tumors. Evidence suggests that laparoscopic partial nephrectomy is equivalent to the open approach in terms of oncologic outcomes and superior in quality of life measures. Objectives: to determine oncologic outcomes regarding tumor free edges and surgical complications in patients undergoing laparoscopic "Zero ischemia" partial nephrectomy and enucleation of renal tumor. Methodology: retrospective, observational, and comparative study, with a universe of patients from Los Angeles private clinic and Caja Nacional de Salud, Hospital Obrero Nº2, Cochabamba, Bolivia, who underwent laparoscopic partial nephrectomy, were grouped in two groups: Group I: partial nephrectomy and Group II: enucleation. The following were analyzed: tumor size and location, RENAL score, surgical time, bleeding, days of stay, complications and histopathological report. SPSS version 20 (IBM, Chicago, IL) was used for statistical analysis. Results: seventeen patients were evaluated, 3 were excluded due to completion of radical surgery, 6 partial nephrectomies (Group I) and 8 enucleations (Group II). Mean age 45.7 (± 8.6) vs 51.2 (± 6.3) years. Tumor size 7.8 (2.5-10) vs 3.2 (1-5.7) cm, The overall RENAL score of all patients was low to moderate, a separate analysis was performed, in group I, the distribution was low complexity 2 (33.3%), moderate n=1 (16.7%) and high n=3 (50%), in group II, low complexity n=5 (62.5%), moderate n=2 (25%), high complexity n=1 (12.5%). There were differences in favor of group II (enucleation) in terms of surgical time and transoperative bleeding, presenting only 1 case with urinary leakage, resolved with placement of a JJ catheter. In terms of surgical edges, there were 2 (14.2%) cases with positive edges, 1 for each approach, which are kept under close surveillance. Conclusions: laparoscopic approach is an option comparable to the open one, equal results were obtained with respect to oncologic control in relation to free edges and with fewer complications, although experience in laparoscopic surgery is required, as well as an increase in follow-up time and a greater number of cases.

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Duplication anomalies of the kidney represent common congenital malformations of the urinary tract. A duplex kidney has often one pole that is poorly or nonfunctioning. In this last case, surgery may be indicated to remove the nonfunctioning pole. The most common indications for partial nephrectomy in pediatrics include symptomatic vesicoureteral reflux to the nonfunctioning pole and/or ectopic ureter or ureterocele causing urinary incontinence. In this article, we describe the technique of laparoscopic partial nephrectomy in infants and children with duplex kidney. A surgical procedure properly executed following critical technical steps is the key factor for the success of surgery.

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Horseshoe kidney (HSK) is a common congenital kidney anomaly that is encountered frequently by urologists. It is rare for HSK to be affected by xanthogranulomatous pyelonephritis (XGP), a potentially life-threatening condition. The standard of care for XGP is open nephrectomy, but recently a few case reports have been published showing the feasibility of minimally invasive surgery to deal with XGP. We present a case of HSK affected by XGP treated successfully with modified laparoscopic transperitoneal heminephrectomy. The rarity of such a combination, the modified approach, and the successful outcome encouraged us to report it.

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A duplicated collecting system is a common congenital anomaly of the urinary tract. However, late symptomatic presentation in adulthood is uncommon. We report the first case of left heminephrectomy, ureterectomy and radical prostatectomy using the da Vinci SP (single port) surgical system in a 64-year-old patient with localized prostate cancer and duplicated system with ectopic ureteral insertion into the prostatic urethra. The procedure was completed without technical difficulties or intraoperative adverse events. We demonstrate that the da Vinci SP robot allows for efficient performance of concomitant surgeries on the kidney and prostate without the limitations reported with single site surgeries.

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INTRODUCTION: Ureteroceles is a developmental anomaly with cystic dilation of the distal aspect of the ureter and are often associated with some urological anomaly such as a duplicated system or stenotic ureteric orifice. PRESENTATION OF CASE: This study reports an ectopic ureterocele in duplication of collecting system associated with double ureters and ureteral ectopia in a woman aged 24 years with minor flank pain. Cystoscopy deroofing of the ureterocele performed and followed by secondary surgery laparoscopic heminephrectomy. DISCUSSION: Ureteroceles have various clinical manifestations and complications. Treatment for ureterocele depends on age, type of the ureterocele, obstruction to the draining system, and complications. No single method is sufficient for all cases, and management must be individualized. Endoscopic treatment has gradually broadened as a safe, minimally invasive, and effective procedure, but there is no consensus on its effectiveness for treating ectopic ureterocele. However, it is reported that 50-80% of cases after initial endoscopic treatment require secondary surgery. CONCLUSIONS: Ureterocele is reported rarely in adults, especially with duplication of the collection system in the nonorthotopic (extravesical) position in women. Cystoscopy deroofing of the ureterocele can be performed to decompress the hydroureteronephrosis, and laparoscopic heminephrectomy can be performed due to dysfunctional uppers moiety. Long-term follow-up is required to monitor renal function, symptoms, and occurrence of vesicoureteric reflux.