Urethral duplication

Urethral duplication (UD) is a rare anomaly usually seen in males and often associated with genitourinary and gastro-intestinal anomalies. Clinical manifestations such as deformed penis, twin streams, urinary tract infection (UTI), urinary incontinence, serous discharge from sinus, out flow obstruction and associated anomalies. It may be complete or incomplete. The accessory urethra often presents as dorsal or ventral midline openings and rarely opens eccentrically (Coronal/collateral). Dorsally opening accessory urethra is the most common type.

Classification

Effmann et al., classified urethral duplication in to 3 types and gave the most exhaustive description.

Type I: Blind-ending accessory urethra (incomplete urethral duplication).

  • IA – Distal-duplicated urethras opening on the dorsal or ventral surface of the penis but not communicating with the urethra or bladder (the most common type).
  • IB – Proximal-accessory urethra opening from the urethral channel but ending blindly in the periurethral tissues (rare)

Type II: Completely patent accessory urethra. It is divided into 2 parts: A (2 meatuses) and B (1 meatus).

  • IIA1 Two noncommunicating urethras arising independently from the bladder.
  • IIA2 Second channel arising from the first and coursing independently into a second meatus (Y-type).
  • IIB Two urethras arising from the bladder or posterior urethra and uniting into a common channel distally.

Type III: Accessory urethras arising from duplicated or septated bladders.

Diagnosis and Treatment

The diagnosis of urethral duplication is performed by clinical history, physical exam and imaging methods, especially voiding cystourethrography. Kidney and bladder ultrasonography is recommended to investigate associated anomalies. Urethrocystoscopy is important for surgical planning.

Stephens and Donnellan reported surgically treating this type of urethral duplication by opening the whole length of the urethra, while the accessory preanal tract was also used for proximal urethral reconstruction. Eventually they closed the marsupialized urethra using the Johansen procedure.

Pic : Voiding cytourethrogram revealing complete urethral duplication with pan-anterior narrowing of the hypoplastic dorsal urethra (red arrowhead) and evidence of ventral urethral reconstruction with prepucial tube with a small diverticulum (red arrow)

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