Complete Duplication of the Bladder and Urethra in the Coronal Plane: Case Report

Abstract

KEY Worn: bladder; urethra; abnormalities, multiple Complete duplication of the bladder and urethra is an unusual congenital anomaly. We report a rare variant of this condition with complete duplication of the bladder in the anteropterior (coronal) plane. There were no other associated congenital anomalies. CASE REPORT A 6-year-old healthy white boy presented for evaluation of recurrent urinary tract infections. Physical examination revealed a normal urethral meatus, an accessory epispadiac meatal fossa and an additional opening on the dorsum of the midshaft of the penis consistent with an accessory urethra. The remainder of the physical examination was normal. An excretory urogram, voiding cystourethrogram and retrograde urethrogram through the normal meatus demonstrated no radiographic abnormalities. Cystoscopy cod%med these findings. A retrograde sinogram through the accessory meatus showed a blind ending channel up to the level of the symphysie pubis. At exploration the accessory urethra was excised up to the level of the pubis, where it appeared to end blindly. The epispadiac meatal fossa was also excised and the glans was reconstructed. Postoperatively the patient was well until 3 months later when he had irritative voiding symptoms associated with induration of the midshaft of the penis. Oral antimicrobials resolved the voiding symptom but not the penile induration. Reexploration was performed at the previous operative site at the area of induration. A residual tubular structure was identitied and incised with subsequent drainage of a small amount of mucopdent material. This apparent tract was cannulated and a sinogram demonstrated connection with an anterior duplication of the bladder in the coronal plane. Subsequently the retropubic space was explored through a Pfannenstiel incision. A thin fibrous septum completely separated the accessory bladder from the native bladder. In addition, the accessory bladder contained a separate urachal ligament. No connection to the native urinary tract was identified. The accessory structures were excised completely and sent for histological evaluation (fig. 1). The child has had no further problems.