Introduction: Duplication of the collecting system is the most common congenital ureteral abnormality. We aimed to describe a robot-assisted laparoscopic pyelolithotomy and a side-to-side pyelopyelosotmy in a patient with a duplex system and a stricture. Methods: A 55 years-old man was referred to our center for right flank pain and proximal stones in the context of an incomplete duplex system. The endourology team tried a retrograde and antegrade approach and were both unsuccessful due to an unpassable stricture distal to the stone. Baseline imaging found an obstructed upper moiety with a cluster of stones in its ureter following by and obstructive stricture, and a renogram showed a split function of 39%. A standard 5 port approach was performed, and both ureters were identified. The, the ureter draining the upper moiety was incised and the stones were extracted. The stricture was identified and excised. The pelvis and ureter draining the lower moiety were also incised longitudinally and the posterior aspect of both ureters was sutured. A stent was advanced, and the anterior aspect of both ureters was closed. Results: The estimated blood loss was 100 mL and the patient was discharged the next day. The stent was removed 4 weeks after and the patients is currently pain-free. A follow up imaging showed resolution of the upper moiety hydronephrosis and excretion of contrast in both ureters through the pyelopyelostomy. Conclusions: A side-to-side pyelopyelostomy is a feasible and safe technique in patients with a a duplex system and obstruction. SOURCE OF Funding: None
