Objective: To present a case of a patient with a duplicated left ureter presenting preoperatively as unilateral hydrosalpinx, chronic pelvic pain, and recurrent urinary tract infections (UTIs). Design: Case report. Setting: A large university-affiliated infertility center. Patient(s): A 37-year-old woman, para 1, with an 18-year history of recurrent UTIs associated with coitus, and chronic pelvic pain with a unilateral hydrosalpinx. Main Outcome Measure(s): Resolution of recurrent UTIs and left flank pain. Result(s): The patient has remained symptom free after laparoscopic resection of the duplicated ureter and portion of the bladder at its point of insertion. Conclusion(s): We show a rare case of a duplicated left ureter presenting as chronic pelvic pain and recurrent UTIs, demonstrating the importance of a thorough chronic pelvic pain workup. (Fertil Steril (R) 2007;88:1677.e1-3. (C) 2007 by American Society for Reproductive Medicine.)