Complete Duplication Research Articles

Lower pole anatomy of horseshoe kidney and complete ureteral duplication: Anatomic and radiologic study applied to endourology.

To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with complete ureteral duplication (CUD), in polyester resin endocasts of the collecting system and in patients submitted to 3D computerized tomography scan (CT-scan). We analyzed seven 3-dimensional polyester resin endocasts of the kidney collecting system obtained from 6 fresh adult cadavers (4 with unilateral CUD and 2 with horseshoe kidney) and CT-scan reconstruction images of kidneys from 24 patients: 6 patients with HK, 8 with CUD and 10 patients without renal anomalies that were used as controls. We analyzed the spatial distribution of the calices, the infundibula diameters, the angle between the lower infundibulum and the renal pelvis (LIP) and the angle between the lower infundibulum and the inferior minor calyces (LIICA). Measurements of the width and length of the inferior infundibulum and the infundibula of the minor calyces, as well as the angles (LIP and LIICA) were made with the aid of the LibreOffice 6.3 software. The data were analyzed with the IBM® SPSS® Statistics. There was no statistical difference in the inferior pole measurements between the groups with anomalies and the control group, both in polyester resin endocasts and CT-scan reconstruction images for LIP. When we compared the LIP in the CT-scan between HK versus CUD (p= 0.003), and HK versus the control group (p= 0.035), we observed statistical difference. The knowledge of spatial anatomy of lower pole is of utmost importance during endourologic procedures in patients with kidney anomalies. In the present study we observed that horseshoe kidneys had more restrictive anatomic factors in lower pole than the complete ureteral duplication.

The consequences of differential origin licensing dynamics in distinct chromatin environments.

Eukaryotic chromosomes contain regions of varying accessibility, yet DNA replication factors must access all regions. The first replication step is loading MCM complexes to license replication origins during the G1 cell cycle phase. It is not yet known how mammalian MCM complexes are adequately distributed to both accessible euchromatin regions and less accessible heterochromatin regions. To address this question, we combined time-lapse live-cell imaging with immunofluorescence imaging of single human cells to quantify the relative rates of MCM loading in euchromatin and heterochromatin throughout G1. We report here that MCM loading in euchromatin is faster than that in heterochromatin in early G1, but surprisingly, heterochromatin loading accelerates relative to euchromatin loading in middle and late G1. This differential acceleration allows both chromatin types to begin S phase with similar concentrations of loaded MCM. The different loading dynamics require ORCA-dependent differences in origin recognition complex distribution. A consequence of heterochromatin licensing dynamics is that cells experiencing a truncated G1 phase from premature cyclin E expression enter S phase with underlicensed heterochromatin, and DNA damage accumulates preferentially in heterochromatin in the subsequent S/G2 phase. Thus, G1 length is critical for sufficient MCM loading, particularly in heterochromatin, to ensure complete genome duplication and to maintain genome stability.

PROCEDURE FOR DEBUGGING REPLICA CLASS ERRORS IN RULE-ORIENTED KNOWLEDGE BASES

The problems of error detection by experts in the rule-oriented knowledge bases of oriented information systems, which occurring at the stage of the knowledge base formation, are considered. It has been determined that such errors are associated with the contradictory opinions of experts and / or the limited (imperfect) description of the subject area. The approaches to their debugging were analyzed. The ways of improving the existing approaches to debugging static errors of the “replica” class and possible ways of applying the obtained solutions to eliminate errors “contradictoriness”, “redundancy”, “incompleteness” have been shown. Considering the requirements for the accuracy of information presentation, the solutions for expanding the content of the definition of the static error of the rule-oriented knowledge base have been proposed. The issues of the influence of the "replica" class errors on the results of output in accordance with the rules of the rule-oriented knowledge base were considered. The possibility of using graph theory methods for solving the problem of debugging errors of the "replica" class has been proved. The algorithmic structures for identifying and debugging errors of the specified class, which in contrast to existing solutions allow to identify duplicate apexes at each rank of the graph to which the rule-oriented knowledge base is amounted to, have been developed. A software implementation of detecting and debugging static errors of incomplete, fragmentary and complete duplication has been developed. Due to usage of recursion, the requirements for preparing an array of input data for processing were reduced. The solutions obtained are compatible with the requirements of DSTU ISO / IEC 9126, DSTU ISO / IEC 14598 and consider the requirements of the Software Quality Requirements and Evaluation family of standards as the value of the apexes of the event tree graph. In the process of solving the problem, the specifics of the functioning of the man-machine system was considered. In particular, the possibility of formalizing various aspects of knowledge (alethic, dissisional, casual, dianistic) and assurance of a given level of operativeness in finding solutions has been accounted.

A Case of Complete Pyeloureteral Duplication With Renal Atrophy at the Right Lower Pole

A Case of Complete Pyeloureteral Duplication With Renal Atrophy at the Right Lower Pole

Complete tubular colonic duplication ending in a common channel as a recto vestibular fistula: A case report and literature review of management options

Colon duplication (CD) is a rare congenital abnormality with varied presentations. We present a neonatal case with complete tubular CD terminating uniquely as a common channel, a single rectovestibular fistula. We summarize surgical management options in CD as well as factors that will help to decide the best surgical treatment in individual cases.

Minimal invasive management of complete renoureteral duplication with upper pole megaureter in children

Renal malformations represent a large part of the pathology referred to the pediatric surgeon. Most of them are diagnosed during pregnancy. We present one case of complete ureteral duplex with upper pole obstructive megaureter managed in a private hospital using minimally invasive methods for both diagnosis and treatment due to good teamwork. We do not want to demonstrate that other investigations are not leading to the same diagnose, we want to highlight an alternative to the classic approach. We hope that our experience is a starting point for further research and that in future radiation and general anesthesia in children will be avoided as much as possible for renal investigations.

Dosage sensitivity and exon shuffling shape the landscape of polymorphic duplicates in Drosophila and humans.

Despite polymorphic duplicate genes' importance for the early stages of duplicate gene evolution, they are less studied than old gene duplicates. Two essential questions thus remain poorly addressed: how does dosage sensitivity, imposed by stoichiometry in protein complexes or by X chromosome dosage compensation, affect the emergence of complete duplicate genes? Do introns facilitate intergenic and intragenic chimaerism as predicted by the theory of exon shuffling? Here, we analysed new data for Drosophila and public data for humans, to characterize polymorphic duplicate genes with respect to dosage, exon-intron structures and allele frequencies. We found that complete duplicate genes are under dosage constraint induced by protein stoichiometry but potentially tolerated by X chromosome dosage compensation. We also found that in the intron-rich human genome, gene fusions and intragenic duplications extensively use intronic breakpoints generating in-frame proteins, in accordance with the theory of exon shuffling. Finally, we found that only a small proportion of complete or partial duplicates are at high frequencies, indicating the deleterious nature of dosage or gene structural changes. Altogether, we demonstrate how mechanistic factors including dosage sensitivity and exon-intron structure shape the short-term functional consequences of gene duplication.

Microhomology-Mediated Nonhomologous End Joining Caused Rearrangement of EMD and FLNA in Emery-Dreifuss Muscular Dystrophy.

Background: Emery–Dreifuss muscular dystrophy (EDMD) is a rare disease characterized by early joint contractures, slowly progressive muscular dystrophy, and cardiac involvement, which includes arrhythmia, dilated cardiomyopathy, hypertrophic cardiomyopathy, heart failure, and sudden death. Methods: Clinical data of the proband and family members were collected. The next-generation sequencing technology was used to analyze the pathogenic variants and copy number variations. Polymerase chain reaction was used to sequence the breakpoints of gene locus rearrangements. Results: Here, we report two siblings with EDMD in a family. The proband, a 17-year-old boy, manifested a dilated right heart, bradycardia, mild muscle weakness, and joint contractures. His younger brother only showed a mild bowing limitation with elevated creatine kinase. Next-generation sequencing revealed the complete deletion of EMD and a rearrangement in FLNA (exon29_48dup) in these two patients. The EMD deletion and partial FLNA duplication were accompanied by a 5 bp overlap (GTCCC) on the background of the FLNA-EMD inversion. These findings support the pathogenic mechanism of microhomology-mediated nonhomologous end joining. Conclusion: We report two siblings with complete EMD deletion and FLNA duplication in a family. A microhomology-mediated nonhomologous end joining event involving EMD and FLNA acts as the underlying mechanism.

Termination of DNA replication at Tus-ter barriers results in under-replication of template DNA

The complete and accurate duplication of genomic information is vital to maintain genome stability in all domains of life. In Escherichia coli, replication termination, the final stage of the duplication process, is confined to the "replication fork trap" region by multiple unidirectional fork barriers formed by the binding of Tus protein to genomic ter sites. Termination typically occurs away from Tus-ter complexes, but they become part of the fork fusion process when a delay to one replisome allows the second replisome to travel more than halfway around the chromosome. In this instance, replisome progression is blocked at the nonpermissive interface of the Tus-ter complex, termination then occurs when a converging replisome meets the permissive interface. To investigate the consequences of replication fork fusion at Tus-ter complexes, we established a plasmid-based replication system where we could mimic the termination process at Tus-ter complexes invitro. We developed a termination mapping assay to measure leading strand replication fork progression and demonstrate that the DNA template is under-replicated by 15 to 24 bases when replication forks fuse at Tus-ter complexes. This gap could not be closed by the addition of lagging strand processing enzymes or by the inclusion of several helicases that promote DNA replication. Our results indicate that accurate fork fusion at Tus-ter barriers requires further enzymatic processing, highlighting large gaps that still exist in our understanding of the final stages of chromosome duplication and the evolutionary advantage of having a replication fork trap.

\u201cType C appendicular duplication with patent vitello-intestinal duct\u2014an unforeseen association\u201d\u2014a case report

BackgroundGastrointestinal duplications are uncommon occurring in 1 in 5000 live births. Small intestine is commonly involved, while appendicular duplications are extremely rare. Vitelline duct anomalies arise due to failure of involution of the omphalomesenteric duct. Their spectrum ranges from a simple umbilical sinus to completely patent omphalomesenteric fistulae. We report here a rare association of complete appendico-cecal duplication with patent vitello-intestinal duct (PVID).Case presentationA 14-year-old girl who presented with complaints of scant, foul smelling, and feculent discharge from umbilicus intermittently since birth was evaluated and diagnosed to have a patent vitello-intestinal duct. At laparotomy, a patent vitello-intestinal tract opening unusually at the ileo-cecal junction was noted. In addition, an appendico-cecal duplication cyst bearing an appendix on the mesenteric side and a 4-cm long orthotopic appendix on the native cecum was found with the duplex cecum sharing a common wall and blood supply. The terminal ileum with the duplication and patent vitello-intestinal duct were excised in toto, and an end-to-end ileo-ascending anastomosis was done. The child is well at 1 year follow-up.ConclusionA complete appendico-cecal (Type C) duplication with ectopically inserted patent vitello-intestinal duct is reported here as an unusual association, discussing its management and the probable disarray in the embryological development.

Duplication of pelvicalyceal system: A rare diagnosis made reliably by use of volume rendering technique on a 384 slice CT machine

A duplex collecting system also known as duplicated collecting system in some literatures, is one of the most common congenital renal tract abnormalities to be found incidentally during evaluation of the person for some other complaints. It shows an incomplete fusion of upper and lower pole moieties which may cause a variety of complete or incomplete duplication defects of urinary collecting system [1]. While considered an anatomical variant we need to keep in mind that these duplex collecting systems may be associated with various complications like vesicoureteric reflux, obstruction or ureterocele. In this study, we are going to discuss a case of a young boy who presented with urinary difficulty, on haematological evaluation it showed renal infection . On further radiological evaluation, patient was found to have duplication collection system.

Ectopic insertion of a duplicated ureter into the prostatic urethra

Abstract
 Description of the clinical case: A 55-year-old male patient consulted due to left lumbar pain and dysuria. A complete ureteral duplication with ectopic ureteral insertion in the prostatic urethra was diagnosed by sonographic study and contrast tomography of the abdomen. Nephroureteroectomy was performed using a laparoscopic approach due to the loss of renal function.
 Relevance: Ectopic ureteral insertion is a rare congenital anomaly that presents with complete ureteral duplication with an incidence of 0.05 to 0.025%. Its diagnosis is even more infrequent in adulthood.
 Clinical implications: The study of the patient by imaging allowed the diagnosis of this rare entity in an adult patient. Laparoscopic nephrectomy was the indicated treatment with a very satisfactory evolution.
 Conclusion: Ureteral ectopy is a rare congenital anomaly. Its diagnosis in adulthood is even less frequent. Contrast ultrasound and CT of the abdomen allowed the diagnosis. Laparoscopic nephrectomy was the treatment indicated for the loss of renal function.

Inserción ectópica de un uréter duplicado en la uretra prostática

Abstract Description of the clinical case: A 55-year-old male patient consulted due to left lumbar pain and dysuria. A complete ureteral duplication with ectopic ureteral insertion in the prostatic urethra was diagnosed by sonographic study and contrast tomography of the abdomen. Nephroureteroectomy was performed using a laparoscopic approach due to the loss of renal function. Relevance: Ectopic ureteral insertion is a rare congenital anomaly that presents with complete ureteral duplication with an incidence of 0.05 to 0.025%. Its diagnosis is even more infrequent in adulthood. Clinical implications: The study of the patient by imaging allowed the diagnosis of this rare entity in an adult patient. Laparoscopic nephrectomy was the indicated treatment with a very satisfactory evolution. Conclusion: Ureteral ectopy is a rare congenital anomaly. Its diagnosis in adulthood is even less frequent. Contrast ultrasound and CT of the abdomen allowed the diagnosis. Laparoscopic nephrectomy was the treatment indicated for the loss of renal function.

Повне подвоєння уретри у хлопчика з епіспадією

Duplication of the urethra is a rare abnormality that can occur with other urogenital tract congenital pathologies. Ischemia at embryogenesis, urogenital sinus defect, Muller`s duct anomaly and incomplete mesodermal fusion are the pathophysiological mechanisms of the pathology onset. Duplication of the urethra diagnostics is based on clinical examination, disease anamnesis, urethrography and magnetic resonance imaging. It is nessessary to consider Effmann and Leibowitz classification, urethras and prostate location and urethral orifice distance on operation of additional urethra removing. Clinical case. Presenting a clinical case of a boy with grade I epispadias and complete duplication of the urethra. Urination was maintained and was performed from the dorsal-epispadic urethra, the ventral urethra was obliterated in the distal region. According to the data of magnetic resonance imaging: double urethra is traced, dorsal – comes out from the anterior parts of the bladder wall, continues along the dorsal surface under the dorsal neurovascular bundle, above the cavernous bodies. The urethra opening is traced at the level of the upper surface of the head of the penis. The distal / ventral urethra comes out from the posterior parts of the lower bladder wall, typically continues down through the prostate embryo, rotated forward between of the corporas cavernosas stipes, and had a typical location with except for the level of the penis head, where it bends and merges with the dorsal urethra, which opens with a single opening. The surgery of excision of an additional urethra on child was performed. During the examination of the child of 6 months after surgery: urination with one stream from the ventral urethra at the apex of the head of the penis, stream freely passes the Nelaton catheter No. 10, child holds urine, there was no complaints. Performing of the next stage of the operation (penis plastic surgery) is planned after 1 year of the previous stage. Conclusions. In cases of epispadias is possible a congenital defect – a complete douplication of the urethra with the ventral urethra obliteration at the top of the head, which may not be determined in epispadias surgery preparation. Doubling of the urethra in boys requires magnetic resonance imaging for a better orientation in the defect anatomy and to determine the tactics of further surgical treatment. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: complete duplication of the urethra, surgical treatment, children.

Altered Heschl's gyrus duplication pattern in first-episode schizophrenia

BackgroundReduced gray matter volumes in the superior temporal gyrus and its subregions, such as Heschl's gyrus (HG) and the planum temporale (PT), have been reported in schizophrenia (Sz). However, it remains unclear whether patients exhibit an altered sulcogyral pattern on the superior temporal plane. MethodsThis magnetic resonance imaging study examined the distribution of HG duplication patterns [i.e., single HG, common stem duplication (CSD), or complete posterior duplication (CPD)] and their relationships with clinical variables and gray matter volumes in the HG and PT of 64 first-episode (FE) patients with Sz and 64 healthy controls. ResultsThe prevalence of duplicated HG patterns was significantly higher and gray matter volumes in the HG and PT of both hemispheres were smaller in FESz patients than in healthy controls. The right CPD pattern in the FESz group was associated with less severe positive symptoms. In the FESz and control groups, CSD and CPD patterns correlated with larger volumes in the HG and PT, respectively. ConclusionThe present results revealed an altered HG duplication pattern at the earliest phase of Sz, which may reflect early neurodevelopmental anomalies. However, reduced HG and PT volumes in the FESz were not explained by this sulcogyral pattern only, supporting the complex superior temporal pathology of Sz.

Complete Colon Duplication with Rectovesical Fistula: A Case Report of a 3-Year-Old Child with Lifelong Obstipation

Duplicates of the gastrointestinal tract are rare malformations, which most commonly become symptomatic and are diagnosed during the first two years of life. In this case report, we will recount the story of a 3-year-old patient, who introduced himself with lifelong, intractable obstipation and intermittently emanating stool from the penis. Intraoperatively a complete duplicate of the colon frame with rectovesical fistula became evident. After three procedures, a temporary ostomy, and a final separation of the septum via multiple colostomy and occlusion of the fistula, the boy is now free of complaints.

Duplicated collecting system

The normal urinary collecting system develops from a single ureteric bud arising from the mesonephric (Wolffian) duct. The ureteric bud migrates to meet the primitive kidney (metanephros), where it develops into the collecting system. Abnormalities in the signaling pathways are thought to result in a variety of collecting system variants, including two ureteric buds arising from the mesonephric duct (complete duplication) or one bud that bifurcates during development (incomplete duplication).1 The incidence of duplication in adults is thought to be approximately 0.7% to 4%, with incomplete duplication more common than complete duplication.

V03-08 TRUE DIPHALLIA: EVALUATION AND SURGICAL CORRECTION OF A RARE CASE OF COMPLETE DUPLICATED PENIS

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-08 TRUE DIPHALLIA: EVALUATION AND SURGICAL CORRECTION OF A RARE CASE OF COMPLETE DUPLICATED PENIS Amr A. Elbakry, Chad Crigger, and Osama Al-Omar Amr A. ElbakryAmr A. Elbakry More articles by this author , Chad CriggerChad Crigger More articles by this author , and Osama Al-OmarOsama Al-Omar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We are presenting a rare case of true diphallia. In this video, we will present our evaluation and demonstrate the surgical technique for management of a patient with complete duplicated penis. METHODS: Our patient is an 11-month-old male who presented initially as 28-day-old that was referred for evaluation of abnormal male genitalia. Physical examination showed duplicated penis with penoscrotal transposition and large scrotal lipoma. VCUG was done and showed Y-shaped duplicated urethra, with normal right urethra and atretic narrow left urethra. Diagnosis was confirmed with US and MRI, that showed complete duplication of the penis with separate two corpora cavernous and a corpus spongiosum and urethra in each penis. We decided to proceed with surgical correction with amputation of the left penis as right penis has the normal urethra evidenced by the VCUG. We started our procedure with performing a cystourethroscopy that confirmed normal right urethra that in continuation with prostatic urethra and bladder neck. Next, bilateral sub-coronal circumferential incisions were made, and complete deglovig of both penises was completed. The lipoma of the scrotum was dissected excised. The left penis was amputated, and the stump was oversewn. Next, we turned our attention to correction of pent-scrotal transposition. The two hemiscrotums were mobilized at the level of the peso-scrotal junction, paying attention to maintain penile skin attached at peno-pubic junction to maintain blood supply. The scrotal flaps were brought ventrally and approximated in the midline in 3 layers. penile skin was trimmed and redistributed for penile coverage. penile skin was approximated ventrally in the midline and was sutured to the foreskin of the left penis. A catheter was left place and dressing was applied. RESULTS: Our procedure was successful with total operative time of 4 hours, minimal blood loss and the patient was discharged home on the same day. Urethral catheter was removed at POD7. There was no reported Complications, no fistula, no wound dehiscence or discharge. Pathology confirmed the diagnosis of accessory penis with normal left and right corpora cavernosum and atretic urethra. CONCLUSIONS: We showed a case of a complete duplicated penis which is a rare congenital anomaly of the genitalia. We demonstrated a surgical technique for correction and reconstruction of the male genitalia in this rare case. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e224-e224 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amr A. Elbakry More articles by this author Chad Crigger More articles by this author Osama Al-Omar More articles by this author Expand All Advertisement Loading ...

V09-10 URETERAL SIDE-TO-SIDE ANASTOMOSIS FOR TRANSECTING INJURY OF COMPLETELY DUPLICATED COLLECTING SYSTEM

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-10 URETERAL SIDE-TO-SIDE ANASTOMOSIS FOR TRANSECTING INJURY OF COMPLETELY DUPLICATED COLLECTING SYSTEM Randall Lee, Aeen Asghar, David Strauss, Michael Metro, and Daniel Eun Randall LeeRandall Lee More articles by this author , Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , Michael MetroMichael Metro More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Iatrogenic injuries commonly occur at the distal ureter. The gold standard for distal ureteral injury is ureteroneocystotomy, however new techniques such as side-to-side (StS) anastomosis have demonstrated safe and comparable outcomes. In a duplicated collecting system, two ipsilateral ureters may drain the kidney into the bladder independently or as a single common ureter which may complicate preoperative planning for ureteral reconstruction. Currently limited literature exists regarding iatrogenic distal ureteral injuries to duplicated collecting systems. METHODS: 51 year old female with a history of left robot assisted hysterectomy which was complicated by flank pain post operatively. Imaging work up revealed a duplicated left collecting system with left hydronephrosis concerning for ureteral injury and obstruction. After failed ureteral stent placement patient underwent percutaneous nephrostomy drainage of both left renal moieties. Patient was evaluated and scheduled for a robotic ureterolysis and reconstruction, and ultimately underwent a robotic assisted side-to-side anastomosis and ureteroneocystotomy as described in our video. RESULTS: Total console time was 241 minutes with an estimated blood loss of 150 mL. There were no intraoperative complications. Patient was discharged with ureteral stent and foley on post operative day one. On follow up, patient with no clinical or radiographic evidence of left ureteral obstruction. CONCLUSIONS: We demonstrate that robot-assisted StS ureteral anastomosis with an intravesical non-refluxing ureteroneocystotomy in a duplicated collecting system is a safe and effective option. This technique allows maximal preservation of ureteral perfusion and reimplantation of one ureter. ICG helps facilitate ureteral dissection and assess ureteral blood supply intraoperatively to aid in successful reconstruction. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e690-e690 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Randall Lee More articles by this author Aeen Asghar More articles by this author David Strauss More articles by this author Michael Metro More articles by this author Daniel Eun More articles by this author Expand All Advertisement Loading ...

Surgical Correction of True Diphallia in a Newborn Male

Diphallia is an exceedingly rare anomaly characterized by partial or complete duplication of the phallus. Approximately 100 cases have been reported worldwide since its initial documentation, and incidence is estimated at 1 in 5 to 6 million live births. Therapeutic management is dependent on the extent of the anomaly, ranging from phallic excision to complex reconstructive procedures in cases of broader systemic involvement. We present the case of congenital true diphallia with associated penoscrotal transposition, bifid scrotum, partial urethral duplication, ventral chordee, large scrotal lipoma and sacral dimple. We further present a review of available literature pertaining to diphallia.