Urethral Duplication Research Articles

Congenital prepubic sinus: Report of two cases

Congenital prepubic sinus is a rare disorder with fewer than 30 cases reported in the literature. The origin of the sinus and its tract is unclear but urethral duplication, cloacal remnant or midline closure defect are amongst the postulated mechanisms for the development of the sinus. Chronic discharge and infection are the main indications for surgery. Although surgery is the definite way of correction, timing and extend of surgery are not well documented due to the limited number of cases. Here we present two cases with congenital prepubic sinus, a four month old girl and a five years old boy, who were admitted with discharge through the external opening of the prepubic sinus which are shown not to have a connection with urinary system and are managed by limited surgical excision. Postoperative courses were uneventful and no relapse or complications were encountered. Histological examination revealed that the sinus tract is lined with squamous stratified epithelium without any other significant finding. Although the classification and definition of congenital prepubic sinus is not clear, extensive imaging modalities and surgical procedures are not necessary in most conditions as these can create additional burden for the patient and the healthcare system and may cause complications at the cost of nothing.

Collateral urethral duplication in an adult with adult polycystic kidney disease.

Duplications of the lower urinary tract are rare congenital anomalies that are usually accompanied by concomitant nonurologic anomalies; they are typically diagnosed in early childhood. In more rare cases these are isolated, leading to diagnosis later. We describe a 50-year-old man who remained asymptomatic and therefore undiagnosed for five decades. His is one of fewer than 20 cases in the literature describing urethral duplication in the coronal (collateral) plane, the more common variant being sagittal (dorsal-ventral) duplication. He is one of only four cases reported without concomitant midline anomaly. Furthermore, he is the sole case associated with adult polycystic kidney disease.

Management of Urinary Incontinence in Complete Bladder Duplication by Injection of Bulking Agent at Bladder Neck Level into the Proximal Urethra.

Bladder duplication is a rare entity in children. The term encompasses a wide spectrum of anomalies from isolated bladder duplication in coronal or sagittal planes to duplicated bladder exstrophy and associated musculoskeletal and visceral anomalies. Given this wide variability, the treatment of these patients is not standardized. We hereby present a female patient with chief complaint of long-standing urinary incontinence who had complete bladder and urethral duplication and pubic diastasis. The patient was treated with bulking agent injection at the incompetent bladder neck and proximal urethra with resolution of incontinence, obviating the need for extensive surgeries.

A Rare Case of Urethral Duplication managed by Simple Meatal Correction

A Rare Case of Urethral Duplication managed by Simple Meatal Correction

A rare case of congenital Y-type urethral duplication

Duplication of urethra is a rare congenital anomaly. We report a case of Y-type of urethral duplication with the accessory urethra arising from posterior urethra and opening in the perineum. The orthotopic urethra was normal. The accessory urethral tract was cored, transfixed and divided. At 1 year of follow-up, the patient has no urinary complaints.

Male urethral duplication: a two-case report and literature review

Objective To summarize the clinical features and treatment of male urethral duplication. Methods The clinical data of 2 cases treated in June 2011 and April 2014 were analyzed retrospectively. The first case was a 5-year-old boy presented with passages of urine from two orifices in the penis. The second case was a 15-year-old boy presented with dorsal chordee and a sinus on the dorsum of the penis. The patient had a small amount of watery discharge occasionally dripping out of the opening for 10 years. The 2 patients underwent retrograde urethrography, which revealed a complete duplicated urethra with the channel arising from the proximal prostatic urethra (class ⅡA2 according to the classification of Effman). The 2 patients underwent excision of the accessory urethra under general anesthesia. Results The pathology reports of the 2 cases were hyperplasia of squamous epithelium and urothelial mucosa. Pathological diagnosis was urethral duplication. The first case was followed up for 1 year with a satisfactory functional and cosmetic outcome. The second case was followed up for 6 months and no watery discharge noticed from the residual dorsal chordee. Conclusions Urethral duplication is a rare congenital anomality affecting mainly boys. Clinical presentation varies depending on the different anatomical patterns of the urethral anatomy. Surgical management must be evaluated for each different anatomical variation. Key words: Urethral duplication; Urogenital abnormalities; Male; Surgical procedures, operative

Epispadias and urethral duplication

Epispadias is the mildest form of the exstrophy-epispadias complex and rarely occurs in an isolated form. The characteristic clinical sign is a mucosal strip on the penile dorsum. Clinically, epispadias presents with urinary incontinence. Primary surgical correction is recommended at the age of 12 months and should only be performed at a specialized center. During follow-up, further bladder neck surgery may be necessary. Despite a functional and cosmetically appealing penis, psychosocial and psychosexual development of the affected individuals can severely be affected. The incidence of urethral duplication remains unclear. Several classifications reflect the anatomical variation. The clinical presentation depends on the continuity of the duplicated urethra and its relationship to the sphincteric mechanism. In addition to clinical examination, a voiding cysturethrography is part of the basic diagnostic workup. After endoscopic examination an individual operative approach can be defined.

Type IIA2 urethral duplication

This report describes a rare case of type IIA2 sagittal urethral duplication. The presentation, investigation, and management of this rare anomaly are briefly discussed. A 3½-year-old boy presented with urinary obstruction and recurrent urinary tract infection due to a stenosed dorsal urethra and segmental stenosis of the dominant ventral urethra. The child also had left-sided vesicoureteric reflux. Staged surgical management consisted of an initial vesicostomy followed by serial dilatation of the ventral urethral stricture, left ureteric reimplantation, and a 2-cm long distal urethrourethrostomy between the dorsal urethra, opening at the tip of the penis, and the ventral urethra, which had a hypospadic opening at the base of the glans. The functional and cosmetic outcomes were satisfactory. The management needs to be individualized as best suited for the patient.Keywords: urethra, urethral duplication, urethral stricture

Combined robotic and open approach to excision of accessory bladder and urethral triplication

Management of urethral and bladder duplication anomalies centers on prevention of recurrent infections and preservation of renal function. We present a surgical approach to urethral triplication and bladder duplication utilizing a combined robotic and open approach. A 17-year-old male presenting with fevers and abdominal pain was found to have two accessory urethras dorsal to a normal orthotopic ventral meatus. A large cavity anterior to the bladder was identified on a computed tomography scan and drained of purulent fluid. After improvement with antibiotics, endoscopic evaluation revealed no distinct connection between the cavities. The patient subsequently underwent open excision of the urethral triplication followed by robotic excision of the accessory bladder. Total console time for the robotic portion was 2 hours 18 minutes and estimated blood loss was 30mL. The dissection was difficult due to reaction from prior infections, but the accessory bladder was able to be dissected off without opening the native bladder. The accessory bladder specimen was consistent with a urothelial lining exhibiting reactive changes. To our knowledge, robotic excision of a urethral/bladder duplication anomaly has not yet been described in the literature. The robotic approach allowed for excellent visualization and is technically feasible.

Q-Island Flap Urethroplasty: 1-Stage Procedure for Reconstruction of Y-Type Urethral Duplications in Children

We review our experience with Q-flap urethroplasty in children with Y-type urethral duplication. Six children with Y-type urethral duplication underwent 1-stage urethral reconstruction using Q-flap urethroplasty between 1988 and 2012. The ventral hypospadiac urethra was always the functional one, and, therefore, was used for urethroplasty. Mean age at surgery was 5 years (range 1 to 13). All 6 patients had an excellent cosmetic result, with a normal appearing penis, a large apical meatus and no skin chordee. All 6 voided normally. None of the 6 children required reoperation. The only complications were urethral stenosis in 2 patients and lower urinary tract infection in 3. Cosmetic and functional results were analyzed during a mean followup of 8 years (range 1 to 12). Q-flap urethroplasty provides a long penile skin flap that allows 1-stage reconstruction in children with Y-type urethral duplication, with good cosmetic and functional results.

Glandular diphallus with urethral duplication: Conventional technique for a rare congenital anomaly

Diphallus is a rare anomaly and its association with urethral duplication is extremely rare. Numerous associated genitourinary and gastrointestinal anomalies have been reported with this condition. Challenges in the management are incorporation of the glans and the dominant urethra during reconstruction. We report the successful management of a case of glandular diphallus with complete urethral duplication retaining the dorsal urethra.

Type II A2 duplication of urethra in an 8-month-old male child: A case report

Urethral duplication is a rare congenital anomaly, usually found with multiple anatomical variants. In this article was presented a case of urethral duplication in an 8-month-old male child. The malformation was characterized by the presence of continent hypospadic and normal apical urethra. Retrograde urethrogram through both urethral tracts simultaneously revealed the malformation as Effmann Type II A-2. The accessory ventral urethra was excised without complication.

Glandular diphallus with urethral duplication: Conventional technique for a rare congenital anomaly

Glandular diphallus with urethral duplication: Conventional technique for a rare congenital anomaly

Megalourethra with Y-Type Duplication of Urethra Presented as Perianal Fistula: A Rare Case Report

Megalourethra with Y-type duplication is an extremely rare anomaly. We report here one such case, diagnosed with retrograde urethrogram, which was done from both penile meatus and perianal opening simultaneously. Patient was successfully treated by laser optical internal urethrotomy (OIU), excision of duplicated urethra, and reduction urethroplasty in a single stage.

İzole Distal Üretra Duplikasyonu: Nadir Bir Üriner Sistem Anomalisi

İzole Distal Üretra Duplikasyonu: Nadir Bir Üriner Sistem Anomalisi

Urethro-urethral fistula: A rare cause of post-TURP incontinence.

Prostatic abscess rarely follows acute prostatitis and can sometimes lead to a fistula by breaking into the prostatic urethra, peri-rectal tissues, the perineum, or the rectum. We report a case of a prostatic abscess tracking into the bulbar urethra after a transurethral resection of the prostate. This created a fistula, mimicking a urethral duplication and leading to urinary incontinence.

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.

A Rare Presentation of Caudal Duplication Syndrome in an Adult with No Functional Impairment

Caudal duplication syndrome is a rare congenital association between malformations and duplications of the gastrointestinal and genitourinary systems and neural tube defects. Less than 100 cases have been reported in literature worldwide, majority being diagnosed at birth. To date only 2 patients have been reported to have presented in adulthood. We hereby report a case of caudal duplication with complete duplication of urethra, bladder, vagina, uterus, entire hindgut and midgut but with no functional abnormalities. Her only complaint being narrow double vaginal vaults with anticipated difficulty in sexual function. As normal pregnancy has been reported in uterus didelphys, a simple vaginal septal resection and posterior vaginal wall lengthening with incorporation of a ‘Z-plasty’ was done along with vulvaplasty to exclude the abnormal anal opening from the fourchette.

Congenital duplication of the urethra with urethral diverticulum: a case report.

Duplication of the urethra is a rare congenital anomaly. Urethral duplication with the presence of diverticulum is a rare combination and to the best of our knowledge has not been previously reported. We report a case of a 16 month old male child with duplication of the urethra and diverticulum arising from the ventral urethra. We also cover the intricacies and challenges in the management of such a case. The opening of the narrowed accessory dorsal urethra at the verumontanum was cauterized and gradually the dorsal urethra became atrophied. The ventral urethral diverticulum was excised. This case is unique due to: The unusual presentation of swelling over the dorsum of the penis, together with duplication of the urethra with diverticulum.The use of cauterization as a treatment modality. Cauterization of the ventral urethra with a Bugbee electrode and diverticulectomy was performed. A glidewire helped in identifying the small opening of the dorsal urethra at the level of the verumontanum.The case also highlights the importance of endoscopic management of this clinical entity.

Congenital duplication of the urethra with urethral diverticulum: a case report

Duplication of the urethra is a rare congenital anomaly. Urethral duplication with the presence of diverticulum is a rare combination and to the best of our knowledge has  not been previously reported. We report a case of a 16 month old male child with duplication of the urethra and diverticulum arising from the ventral urethra. We also cover the intricacies and challenges in the management of such a case. The opening of the narrowed accessory dorsal urethra at the verumontanum was cauterized and gradually the dorsal urethra became atrophied. The ventral urethral diverticulum was excised. This case is unique due to: The unusual presentation of swelling over the dorsum of the penis, together with duplication of the urethra with diverticulum. The use of cauterization as a treatment modality. Cauterization of the ventral urethra with a Bugbee electrode and diverticulectomy was performed. A glidewire helped in identifying the small opening of the dorsal urethra at the level of the verumontanum.  The case also highlights the importance of endoscopic management of this clinical entity.