Urethral Duplication Research Articles

Long-term Morbidity of Martius Labial Fat Pad Graft in Vaginal Reconstruction Surgery

To assess the long-term morbidity of Martius labial fat pad (MLFP) interposition in vaginal reconstruction procedures at a tertiary institution. After institutional review board approval, medical records of consecutive women in a prospective surgical database requiring MLFP as part of their vaginal reconstruction were reviewed for demographics, indications for MLFP, complications, and outcomes, with minimum of 6 months follow-up. Three MLFP groups were compared as follows: (1) vesicovaginal fistula, (2) bladder outlet obstruction, and (3) others. Patients were contacted by mailed survey and/or structured telephonic interview with Quality of Life score, validated Female Sexual Function Index questionnaire, and a specific question addressing Martius harvest site, that is, "pain or numbness in labia". Between 1996 and 2011, 122 women met inclusion criteria, with 25 excluded for lack of follow-up details or death. Mean age was 54 years (range, 19-78), with mean BMI 28 kg/m(2) (range, 19-43) and mean follow-up of 85 months (range, 6-202). Indications for MLFP included vesicovaginal fistula (20), bladder outlet obstruction (60), and others (17) (bladder neck closures, urethral diverticulum, and excision of duplicate urethra). No perioperative complications were recorded. Of the 97 women, 79 (81%) had normal sensation, with 5 (5%) reporting pain and 13 (14%) reporting numbness, respectively. Nine (7%) reported distortion of labia majora. Of the 29 women reporting sexual activity, only 26 (27%) responded to Female Sexual Function Index questionnaires with equivocal sexual function outcomes between all 3 surgical groups. The MLFP has minimal early and delayed morbidity at mean 7 years follow-up.

Valvas ureterales: revisión de la literatura y descripción de 4 nuevos casos

Ureteral valves are a rare malformation, with an incidence of 1 in 5000-8000 live births. Urological malformations are associated with 50% of cases according to the current literature. We report 4 cases treated in our hospital from 2004 to 2012. Three of the patients had renal dysgenesis, one case associated with complete urethral duplication, and another case associated with a ureteral atresia.

Urethral duplication – A wide spectrum of anomalies

ObjectiveUrethral duplications are rare lower urinary tract anomalies, with multiple anatomical variants described. This paper aims to separate this complex anomaly into different diseases, each with distinct clinical forms according to the disturbance during embryogenesis, yet noting a few similarities that may be helpful in their management. The classification system of urethral duplication is also discussed. Material and methodsTwelve urethral duplication cases over a 14-year period were reviewed. Clinical presentation, the imaging studies used to ascertain anatomical details, type of urethral duplication and surgical correction used in the treatment of patients are presented. ResultsNine patients had urethral duplication in the sagittal plane and three patients in the coronal plane. Of the patients with sagittal urethral duplication, 3 had pre pubic sinus, 3 had epispadiac urethral duplication, 1 had a dorsal urethral duplication deviated from the midline and 2 had hypospadiac urethral duplication. All the patients with coronal urethral duplication had associated bladder duplication. The surgical correction of the patients with sagittal urethral duplication included excision of the pre pubic sinus, excision of the duplicated urethra, and urethroplasty. Excision of the hemibladders' septum and closure of one bladder neck was the treatment for patients with coronal urethral duplication and bladder duplication. ConclusionUrethral duplication is a complex anomaly and the different manifestations probably have different embryological origins. Each group, sagittal or coronal, has a few similarities that may be helpful in their management, although every diagnosed case presents a unique anatomy and surgical treatment must be individualized.

Bladder exstrophy associated with complete urethral duplication: Bladder can be augmented with dorsal urethral mucosa

Bladder exstrophy associated with complete urethral duplication is very rare with only 8 reported cases in the English literature. This is a report of a16 years old boy who had originally been diagnosed with only bladder exstrophy but was discovered to have a normal ventral urethra intra-operatively during penile disassembly. The mucosa of the dorsal urethral plate was transected at the corona and mobilised proximally to augment the bladder. The ventral urethra was preserved and the bladder closed. At 14 months follow up he is voiding normally, has adequate bladder capacity and a normal penis. Post operative voiding cystogram shows bilateral grade 2 vesicoureteric reflux.In conclusion, bladder exstrophy with urethra duplication is rare and the diagnosis usually missed. The mucosa of the dorsal urethral plate can be preserved and used to augment the bladder.

An unusual variant of urethral duplication: an addition to the Effman classification

A rare association of horseshoe kidney with pyelic fusion with crossed single ureter along with a rare unusual variant of complete urethral duplication is described. We review the available literature on this rare association and present its management.

A New Variation of Urethral Duplication

Urethral duplication is a rare congenital anomaly. This case study intends to define a new anatomic variation of an accessory urethra. The case is a 5-year-old boy who presented with dorsal chordee requiring operative intervention. At surgery, an accessory urethra on the dorsum of the penis was detected. It was observed that the distal part of the accessory urethra had no external opening and the proximal part had no connection with the native urethra. The accessory urethra was completely excised without complication. To our knowledge, this type of accessory urethra is the first reported case in the English literature.

Duplicidad uretral. La importancia de una anamnesis y una exploración física detalladas

Urethral duplication is a rare disease, only approximately 200cases having been reported worldwide. There are several subtypes of urethral duplication, the most frequent subtype being 2A-Y. We report a case of urethral duplication 2A-2, little reported in the current literature. It was diagnosed as incidental finding during endoscopic urological surgery. The symptoms of this congenital malformation depend on the subtype of urethral duplication. They can be completely asymptomatic or present as part of a complex caudal malformation.

Two Cases of Dorsal Urethral Duplication

Abstract Urethral duplication is a rare congenital anomaly. In addition to a normally urethra, there is an accessory urethra arising from the bladder or the proximal urethra which may open anywhere on the penis or even on the perineum. Many patients with this malformation are asymptomatic. Some patients may complain of intermittent discharge from the accessory urethra, incontinence, infection, double streams or stricture. The duplicated urethra may be complete or incomplete, may be located dorsal, ventral or in Y-type. The treatment of urethral duplication is individualized, depending on the type of malformation. We report two cases of dorsal urethral duplication discovered in two boys.

Y-type urethral duplication in children: Management strategy at our center

Aims:Report of seven children with Y-type urethral duplication (YUD).Materials and Methods:(A) Four staged operations were performed in patients having extensive perineal dissection (for rectourinary fistula separation and anterior mobilization of ventral urethra (VU)), tension rectocutaneous anastomosis, and children who were not toilet trained). These stages are (1) diversion sigmoid colostomy with anterior mobilization of VU as perineal urethrostomy via anterior sagittal approach; (2) Orthotopic urethral (OU) reconstruction; (3) anastomosis of OU and perineal urethra; (4) colostomy closure with management of complications. (B) The patients having VU onto the perineum underwent single stage urethral reconstruction.Results:The VU was urethrorectal/urethroanal in five and urethroperineal in two. Low anorectal malformation and upper urinary tract anomalies were present in 57.1% (4/7) and 14.7% (1/7) patients, respectively. Buccal mucosa free graft, transverse inner preputial flap, and perineal skin were tubularized for OU reconstruction. Mean age at 1st , 2nd , 3rd , and 4th surgery was 5 ± 0.78, 28 ± 0.78, 36 ± 0.78, 49 ± 0.78 months respectively. Three patients needed surgery for complications (urethrocutaneous fistula in two and urethral diverticulum in one) in a mean 3.12 ± 0.34 years of follow-up. Final uroflowmetry and fecal continence were good in all patients.Conclusions:The YUD is a difficult entity to manage. Although, staged procedure appears to be time consuming, but good and promising results can be achieved by staging the procedure.

Congenital prepubic sinus: A variant of epispadiac dorsal urethral duplication

Congenital prepubic sinus is a tract originating in the skin overlying the base of the penis. Its embryologic basis is still debated. We present a 9-month-old boy with a recurrent muco-purulent discharge from a tiny opening in the midline prepubic area on the base of the penis. Examination revealed a ventrally hooded prepuce, dorsal chordee, penile torsion to the left, and a 3-mm-diameter prepubic sinus 1 cm from the base of the penis. Histology of the excised tract showed a transitional epithelium. We believe our case is an epispadiac variant of dorsal urethral duplication.

Urethral duplication II-A Y type with rectal urethra: ASTRA approach and tunica vaginalis flap for first stage repair

Urethral duplication is a rare congenital anomaly affecting mainly boys. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. We present a patient with urethral duplication in which the orthotopic urethra was patent in the penile segment but atresic in the bulbar and prostatic segment. The patient had urinary flow from the rectum and the ectopic urethra could be well identified by anal examination. Age at surgery was 13 months. The procedure consisted of an ASTRA (anterior sagittal trans-ano-rectal) approach for dividing the urethra and rectum and was successful to move the urethra up to the perineal area. The rectum was reconstructed and the patient placed into a lithotomy position. A urethral catheter inserted in the penile urethra oriented us were the atresic urethra in bulbar area started. The scrotum was opened in the middle and the distance between the two urethral stumps proximal and distal defined the extension of no urethral tissue that consisted of 5 cm. We opened the right scrotal space and a tunica vaginalis flap was obtained and attached to the bulbar tissue for a two-stage urethroplasty strategy. Patient had a nice healing and the tunica vaginalis was nicely incorporated to the adjacent tissue, having the two urethral stumps well delineated. ASTRA approach in combination with a two-stage urethroplasty with tunica vaginalis dorsal flap proved to be an excellent combination for a rare case of urethral Y duplication having the main urethra into the rectum.

Urethra duplication with bladder outlet membrane obstruction

Urethral duplication is rare and procedures of management should be individualized according to each case's anomaly.

Urethral duplication: Case report and literature review

Urethral duplication is a rare congenital genitourinary abnormality. The purpose of this report is to add to the scanty literature on the subject. We emphasize the significance of high index of suspicion, thorough evaluation, and to discourage circumcision performed by unqualified individuals. A six year old with a finding of urethral duplication is presented along with the review of the literature.The patient presented with of passage of urine from 2 orifices on the penis following circumcision, six months prior presentation. He voids with double streams - clear urine and the other haematuria. Examination revealed a normal primary urethral meatus and an accessory opening on the corona of the dorsal surface of the phallus. No other abnormality detected. Patient had single stage urethroplasty with good outcome. Urethral duplication is rare. Diagnosis requires a high index of suspicion. Optimal knowledge of the duplication is significant for the managing surgeon in order to avoid complications. The overall outcome is good.

Urethral duplication: a rare cause of urinary incontinence in a female child

Female urethral duplication is a rare congenital anomaly. We report a case of complete urethral duplication along with horseshoe kidney in a four-years-old female child presenting with incontinence since childhood.

Urethral duplication: Experience of four cases

Aim:Our experience of 4 cases of urethral duplication is reported here.Materials and Methods:A retrospective chart review.Results:The age at presentation varied from newborn to 10 years. The clinical presentation ranged from prepubic sinus to diphallus urethra. There were 2 each incomplete duplication with only external openings (Type IA) and complete duplication of Effmann Type IIA2. All underwent complete excision of accessory urethra and corrections of associated anomalies.Conclusions:Urethral duplications have a varied presentation. At follow up, all are asymptomatic with good cosmetic result.

Complete Bladder and Urethral Duplication With Normal Urodynamic Function Associated With Visceral Sequestration

Complete bladder and urethra duplication is an extremely rare condition. It can occur in the sagittal or coronal plane, depending on the axis of the septum. Most cases are associated with other congenital defects. We present a case of complete duplication of the bladder and urethra in the sagittal plane with normal urodynamic function associated with bowel sequestration.

Penile duplication: Is it necessary to excise one of the penises?

A 37-day-old boy presented with a duplicated penis. Examination revealed presence of two penises, one dorsally located and one ventrally, a large left inguinal hernia and absent right thumb. Abdominal ultrasound and micturating cystourethrogram showed normal kidneys, a single urinary bladder, and partial urethral duplication with no vesicoureteric reflux. The patient was subjected to a new technique, reconstructing the penis without removal of corporal tissue, and therefore not compromising its size. A satisfactory result was achieved. The case is being reported due to its rarity and different surgical approach, in contrast to previous reports of management of diphallia involving excision of one of the penises.

Complete urethral duplication: Description of surgical approach mimicking distal epispadias repair

ObjectiveTo present two cases of type IIA urethral duplication and propose a reproducible surgical approach. MethodsTwo cases are presented in this report. The first was a male child with a type IIA1 urethral duplication with two urethral channels arising from the bladder through separate bladder necks coursing to the glans penis. The second infant had a type IIA2 urethral duplication with a single bladder neck. Both children were repaired using a surgical approach that joined both urethral openings into a single orthopic meatus. This was accomplished by incising the common septum and utilizing techniques similar to that of a distal epispadias repair. ResultsAt six months of follow-up both infants are voiding from a single stream without complication. Long-term outcomes remain to be determined. ConclusionsThe technique presented in this report both functionally and cosmetically unites the two urethral meatuses while eliminating the risk of damage to the sphincter.

Female Covered Urethral Duplication With Urogenital Sinus

We report a covered urethral duplication in a girl presenting prenatally with an enlarged fluid-filled vulvar cyst, genital duplication, and urogenital sinus revealed by fetal magnetic resonance imaging (MRI) and serial ultrasounds. Physical examination revealed an enlarged vulvar mass covering the clitoris, a single orifice, and normally sited anus. Congenital adrenal hyperplasia was ruled out at birth. MRI in addition showed an accessory duct between the sinus and the urine-filled vulvar pouch with a bifid clitoris. A total urogenital sinus mobilization with resection of the accessory urethra and vulvoplasty was performed with uneventful follow-up.

Urethral duplication in a 12-year-old child

Urethral duplication is a rare congenital malformation affecting mainly boys. The authors report a case in a Cameroonian child who was diagnosed and managed at the Gynaeco-Obstetric and Paediatric Hospital, Yaounde. The malformation was characterized by the presence of an incontinent epispadic urethra and a normal apical urethra. We describe the difficulties faced in the management of this disorder in a developing country.