Double Urethra Research Articles

Missed urethral duplication associated with hypospadias, post-hypospadias repair urethral stenosis, and recurrent urinary tract infections in an adult: a case report

BackgroundDuplication of urethra is a very rare congenital disorder. Several types of this anomaly have been reported around the world, and are also discussed in this report. However, the mechanism of this anomaly is still unclear.CaseA 45-year-old Persian man with a complaint of recurrent urinary tract infection was referred to our clinic. He had a history of repairing penoscrotal hypospadias in childhood along with obstructive and irritating symptoms in adolescence. On his last voiding cystourethrogram and retrograde urethrogram, stenosis was observed in the proximal bulbar urethra along with a double urethra in the dorsal region of the main urethra. The double urethra was removed with operation, and he was followed for 1 month after surgery. He had no complaints of recurrence or urinary incontinence.ConclusionsThis report shows the different classification systems, types of double urethra, and approach and management, which mainly involves surgery; however, surgical management should be done according to the anatomical findings of the abnormality.

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.

URETHRAL DUPLICATION A RARE CAUSE OF EVEN RARER DORSAL CHORDEE

Chordee is a condition in which the penile head has a curvature. It can be towards ventral or dorsal aspect. Dorsal chordee is very rare. In many normal males mild degrees of curvature can exist. Causes of dorsal chordee can be diverse but urethral duplication as its etiology is even rarer. We report a case of six year old boy who presented with severe dorsal chordee with associated double urethra and cleft of the glans dorsally without hypospadia.

HP-06-005 Does double urethra give double ejaculatory pleasure? An example of surgical reconstruction

HP-06-005 Does double urethra give double ejaculatory pleasure? An example of surgical reconstruction

Practical and functional classification of the double urethra: A variable, complex and fascinating malformation observed in 20 patients

Urethral duplication is a rare and variable malformation of the urinary tract, with non-univocal and complex management. In addition, different classification schemes have been proposed, but none have considered all the possible variants. To report experience with the management of 20 urethral duplication patients and propose a classification of this anomaly. A retrospective analysis collecting information regarding 20 patients (Table) with urethral duplication treated at a single institution over the past 40 years. Three females and 17 males were treated: two had vesico-urethral duplication, eight had urethral duplication with a single bladder, and eight had 'λ' duplication. Immediate postoperative complications included urethral dehiescence (n = 1) and urethral stenosis (n = 2). The progressive augmentation by dilating the urethra (PADUA) technique was ineffective. During follow-up, the following were recorded: urinary incontinence (n = 2), urinary tract infection (n = 3), hypertension (n = 3) and erectile dysfunction (n = 1). All patients were satisfied with the aesthetic result. Urethral duplication is a rare anomaly with male preponderance. Four types of duplication were described, on the basis of anatomy and management: vesical and urethral duplication (type 1), urethral duplication with single bladder (type 2), 'λ-type' duplication (type 3) and 'miscellanea' (multiple urethral channels, spindle urethra, other female forms, type 4). A full description of the malformation and surgical approach was given for each type. The advantages of the classification were compared with the literature. The proposed classification should be a useful tool, based on the required surgical approach, even if surgery should be tailored to the patient. It is important to restore the anatomy and achieve urinary continence. Surgery can be challenging and a multi-step process, especially in cases of 'λ' duplications.

The double urethra: revisiting the surgical classification.

The aim of this article was to describe our experience with 14 patients with double urethra. We retrospectively examined the patients' records including their clinical presentations, investigations, operative findings, and outcome. In addition to Effmann's classification, we used a newly proposed classification that depends on the orientation of the double urethral channels. During the last 15 years, 18 patients were diagnosed to have double urethra at our pediatric surgical unit. We excluded four patients with 'Y-type' urethral duplication. The remaining 14 patients were divided into either sagittal or collateral duplication. Their age at presentation ranged from the neonatal period to 9 years. The sagittal urethral duplication included 12 male patients. All patients had two urethral channels, one above the other. The dorsal urethral channel was always characterized by poor function and ectopic course. The ventral channel was always the more functioning urethra, with a normal course from the urinary bladder to end either at an orthotopic meatus (subgroup A), or more proximally in a hypospadiac location (subgroup B). The collateral urethral duplication included two patients. Both patients were associated with duplication of the urinary bladder and the external genitalia as a part of caudal duplication syndrome. In this group, both urethrae had comparable function, lying side by side, and each draining a separate urinary bladder. The double urethra is a diverse spectrum comprising different pathologies. Our proposed classification system of duplicated urethras is clinically relevant as it guides surgical management and allows prognostication of outcome.

Female double urethra: a case report

Female double urethra is a very rare anomaly, with less than 40 cases reported since 1970. Most reported cases of double urethra are in the sagittal plane and tend to be stenotic. We describe a 4-year-old girl with double urethra, which was not stenotic and was in the coronal plane. Double urethra should be excluded among other causes in any girl who is incontinent beyond the continence age.

Patent urachus with double urethra and testicular teratoma: A rare association

In this paper, we aim to highlight a case report of a rare association of anomalies comprising patent urachus, double urethra and development of testicular teratoma.

Sigmoid Kidney Associated with Double Urethra

An unusual case of crossed renal ectopia (sigmoid kidney) in an adult, compounded with double urethra, is being presented for its rarity and mode of presentation.

Case of the season “Double Urethra”

Introduction and objective Double urethra means duplication of urethra which may be complete or incomplete. Double urethra is a very rare congenital urogenital anomaly. Less than 200 cases have been reported till date. The objective is to report this rare case which can be diagnosed accurately with strong clinical suspicion and micturating cystourethrogram (MCU). Case A two and half year old boy presented with double urinary stream since birth. MCU was done with proper technique. Results Contrast filled two urethra extending from bladder base to glans penis seen in its entire length confirmed the diagnosis of complete duplication. Conclusion Though it is a rare congenital anomaly, clinical suspicion and typical feature in MCU confirm the diagnosis.

Urethralduplikatur

Urethral duplication is a rare anomaly that can occur in various forms. Urethral duplication must be diagnosed and adequately treated. Only if clinical complaints develop should surgical management be considered. The aim of this study was to retrospectively analyze patients with congenital urethral duplication: age at the time of diagnosis, type of urethral duplication, diagnostic and therapeutic measures as well as clinical aftercare were evaluated. This homogeneous and selected cohort included nine male children. The average follow-up was 6.2 years. Seven children were symptomatic (77.7%). We found a double urethra with epispadias in four boys and with hypospadias in three boys and urethral duplication with perineal/anal meatus in one patient and normotopia in another patient. In two children without symptoms, the urethral duplication was an incidental finding during diagnostic work-up for other anomalies. Seven children had additional urological anomalies: one fusiform megalourethra, three urethral valves with hypospadias, and two epispadias. Two children without symptoms were managed conservatively. An open operation joining the urethras was performed in three children, and four boys underwent endoscopic treatment of the urethral duplication. Long-term results revealed normal continence in all of the children. One child exhibited recurrent urinary tract infections and late stricture, which was opened endoscopically in a second session. A surgical approach is only indicated in the presence of clinical complaints. There is no surgical gold standard. The decision is ultimately reached on an individual basis depending on the findings and anatomy in view of the rarity and variability of the clinical picture. The functional result is of foremost importance for the urethra that requires reconstruction, but the cosmetic aspect should be respected to the same extent. We present the results of our experience in treating children with this urological condition. At the same time larger (multicenter) studies are needed, which will make it possible to formulate guidelines for this rare anomaly.

A rare association of urogenital duplication and anorectal malformation

An unusual case of urogenital duplication in association with anorectal malformation is presented. A 3-year-old girl was referred to the authors' hospital with double vagina, double urethra, double sacrum, double ureters on the right side, multiple vertebral anomalies, together with anorectal malformation. Successful surgical reconstruction was performed. J Pediatr Surg 37:1623-1625. Copyright 2002, Elsevier Science (USA). All rights reserved.

Double urethra, double bladder, left renal agenesis, persistent hymen, double vagina, and uterus didelphys: A case report

A patient with a suspected müllerian anomaly was evaluated with an intravenous pyelogram (IVP), vaginoscopy, laparoscopy, cystoscopy, and vaginal exploration. The patient was noted to have a double urethra, double bladder, left renal agenesis, persistent hymen, double vagina, and uterus didelphys. She was managed conservatively with removal of the persistent hymen and vaginal septum. A review of similar anomalies is discussed and a plausible embryological explanation for this anomaly is offered.

Rare combination of double bladder, double urethra, dextrocardia, situs inversus, and anomalies of the genital and skeletal systems

A rare case of mirror-image dextrocardia with inverse visceroatrial relationship associated with a double symphysis pubis and splitting of the lumbosacral spine and duplication of the bladder and urethra is reported. The clinical findings and investigations are described. An embryological explanation is also suggested.

Caudal Duplication Of Hind Gut And Lower Genitourinary Tract In A Female Child

AbstractTwo year old, with congenital anomaly of duplication of hind gut upto sigmoid flexor with one open end and other closed, as well as double bladder and double urethra opening below two clitoris and two vaginal vaults is presented.

Case report of a boy with penoscrotal transposition, double urethra, pseudodiphallia, and ectopic scrotum

The paper describes a 14 year old Saudi boy with penoscrotal transposition and double urethra placed side by side in the penis. Ectopic scrotal skin and a pseudopenis were seen over the right ischial tuberosity. The patient had a large lumbosacral lipoma, which probably caused paralysis and atrophy of the right leg through an intraspinal extension.

One Case of Incomplete Double Urethra

Duplication of the urethra within a single penile shaft is a rare anomaly. These can be divided into those that are in the sagittal plane, which is most common, and those that occur side by side. In some cases, the accessory channel is complete, having a separate bladder opening and no communication with the more normal ventral urethra. In other cases, the accessory urethra is incomplete, either ending blindly or communicating with the urethra distal to the bladder neck. We report on a 20-year-old male with incomplete double urethra.

Normal and abnormal development of the anorectum

A study of the development of hereditary anorectal malformations in pig embryos resulted in major corrections of all current theories concerning normal and abnormal anorectal development. The principal event in anorectal development proved to be a shift of the dorsal part of the cloaca and the adjacent gut to the body surface of the tail groove. Regression of the dorsal part of the cloacal membrane forms an essential part in this process. Agenesis of this part to the membrane blocks the normal shift of the anorectum of the body surface with anorectal malformation as the result. The subtype of anomaly appeared to depend on the size and the form of this defect. Thus, small defects resulted in stenotic, ectopic perineal, and vulvar/vestibular orifices, and larger defects led to anal and anorectal agenesis. In all cases, an ectopic anal communication ("fistula") to the skin or the urogenital system developed but this was eventually lost in some cases by epithelial regression. A basic similarity between man and pig in both the normal development of the anorectum and in the morphology of the anorectal anomalies makes it likely that the same pathogenetic principle also applies to man. Deformities of the cloacal membrane may also form the basis of other congenital malformations of cloaca-derived orifices such as hypospadia, epispadia, vesical and cloacal extrophy, double urethra, and cloacal membrane agenesis.

Recurrent urinary tract infection With persistent wolfhan duct masquerading as duplicated urethra

An ectopic ureter, which presented on the perineum immediately below the urethral meatus and communicated with the bladder, served as a nidus for relapsing Pseudomonas aeruginosa urinary infections in a forty-nine-year-old woman. The structure between the bladder and perineum simulated a double urethra and probably represented a persistent Wolfean duct.

Interurethral fenestration for a case of double urethra with hypospadias

Interurethral fenestration for a case of double urethra with hypospadias