Urethral Reconstruction in a Patient with Y-Type Duplicated Urethra

Abstract

Purpose Urethral duplication is a rare congenital anomaly. We report the clinical presentation, imaging findings and surgical treatment in a patient with Y-type duplicated urethra. Material and Methods 2 years old boy presented to our clinic with voiding through his anus and urine dribbling from the urethral meatus at the center of the glans. He had an urethral meatus and a second anal urinary meatus on physical examination . Retrograde and voiding cystourethrograms and cystourethroscopy showed the Y-type urethral duplication with stenosis of the dorsal orthotopic urethra and a ventral dominat urethra placed in the anal opening that was functionally normal. The patient was treated with 2-stage urethral reconstruction. At first, ventral dominant anal urethra was transposed to the perineum followed by urethroplasty 6 months later. Proximal to distal steps of the urethroplasty were; 2 cm penile skin tubularization, 4cm preputial island flap tubularization, marsupialization of the dorsal orthotopic urethra, 2cm preputial inlay grefting between the incised dorsal urethral plate, preputial onlay flap to augment the dorsal urethral plate and finally tubularization of all parts to form ‘Thiersch type’ neourethra. Results After 1 year of follow-up, no urethrocutaneous fistula developed and the patient now voids spontaneously through a meatus located normally at the tip of the glans. Conclusions While the ideal surgical management of urethral duplication anomalies remains uncertain, we used a combination of surgical techniques to correct this severe malformation.