Incidental ureteral triplication discovered during surgery for severe hydronephrosis: a case report

Introduction: Ureteral triplication is an exceptionally rare congenital anomaly of the upper urinary tract, with fewer than 100 cases reported worldwide. Preoperative diagnosis remains challenging, particularly in low-resource settings. Presentation of Case: A 3.5-year old boy presenting with dysuria and intermittent severe left flank pain. Initially diagnosed as ureteral duplication with hydronephrosis. Due to limited access to advanced imaging modalities, no further diagnostic evaluation was performed. Intraoperative findings revealed type 3 ureteral triplication with marked hydroureteronephrosis of the upper moiety and non-functioning moiety. The patient underwent a successful partial nephroureterectomy. Discussion: Ureteral triplication may be misdiagnosed as duplication, especially when advanced imaging is unavailable. In such settings, improved ultrasonographic assessment and increased clinical awareness are essential. Low-cost strategies, including standardized ultrasound protocols and tele-radiology consultation, may enhance diagnostic accuracy. Conclusion: This case shows that ureteral triplication can be missed when relying only on ultrasound, especially in resource-limited settings. Improved training and careful evaluation can help detect such anomalies earlier and guide better management.