Introduction Vesico-Ureteric junction obstruction (VUJO) is rarely associated with Pelvi-Ureteric junction obstruction (PUJO). It is usually diagnosed at surgery for PUJO requiring further interventions. We aim to assess the incidence of combined obstructions, outcomes, length of stay, complications and imaging to improve pre-operative investigations and avert unplanned surgery. Methods We retrospectively analysed patients presenting with PUJO and VUJO over 20 years (2003-2023). The demographics, imaging, length of stay, further surgical interventions, and complications were collected. The data were analysed using simple mathematical formulae as case numbers are insufficient for statistical calculation. Results Out of 26 PUJO cases, 8 had VUJO (30.76%). One was identified pre-operatively, others were recognised intra or post-operatively. The hospital stay of patients with PUJO and VUJO is longer (5.8 days vs 2.3 days), with patients requiring at least one further operation. They had a higher complication rate of 37.5%. Two patients (25%) showed improvement in renal function on a MAG3 scan post-op, with 37.5% having some ongoing hydronephrosis on ultrasound scan. Revisiting the imaging including serial ultrasound & nuclear medicine scans did not reveal cues to the diagnosis retrospectively. Conclusion The low rates of pre-operative diagnosis of combined obstructions are comparable to the literature. The rates of both obstructions in our study were high at 30.76%, portentous of miscoding of PUJO. Double pathology of PUJO and VUJO should be suspected in patients with non-resolving hydronephrosis post PUJO surgery, if not diagnosed intra-operatively. This study does not support additional investigations for pre-operative planning for PUJO surgery.