Abdominal CT scan can be helpful in difficult diagnostic situations. The area between the two collecting systems is devoid of any major vessels or collecting system elements. When a transverse cut is made at this interface, only renal parenchyma is visible. A voiding cystourethrogram is essential for all patients suspected of having a duplicated collecting system with an ectopic ureter. The lower pole ureter is more likely to reflux due to its short submucosal tunnel.
Vesicoureteral reflux is the most common abnormality associated with complete ureteral duplication.
An ectopic ureteral orifice in the urethra is not particularly difficult to localize cystoscopically. However, it can be extremely difficult to localize in the vagina. Usually it is located in the anterior and lateral portion of the vagina in the region of the Gartner's duct. In the majority of cases, the affected renal unit is developmentally abnormal and severely damaged by pyelonephritis. Excision of the abnormal renal unit and affected ureter is generally curative.