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Bladder exstrophy associated with complete urethral duplication: a rare malformation with excellent prognosis
J L Pippi Salle1, H Sibai, A I Jacobson
1Divisions of Pediatric Urology, Casablanca Children's Hospital, IbnRochd University Health Center, Casablanca, Morocco.
The Journal of Urology
|May 24, 2001
Summary
Complete urethral duplication associated with bladder exstrophy is rare in males. Surgical management involving excision of the dorsal urethral plate and maintaining the ventral urethra leads to continence and normal voiding.
Area of Science:
- Urology
- Pediatric Surgery
- Developmental Biology
Background:
- Bladder exstrophy is a congenital anomaly requiring surgical correction.
- Complete urethral duplication is a rare, often undiagnosed, condition associated with the exstrophy-epispadias complex.
Observation:
- Five male patients with single bladder exstrophy and complete urethral duplication were identified.
- Most patients presented with incontinence and leakage from the penis during the Valsalva maneuver.
- Associated findings included a deeply situated bladder plate, normal penis size, and less severe chordee.
Findings:
- Preoperative diagnosis of urethral duplication was made in only one patient.
- Surgical treatment involved excising the dorsal urethral plate and preserving the ventral urethra.
- Postoperatively, all patients achieved continence and normal voiding with good penile cosmesis.
Implications:
- A high index of suspicion is crucial for the preoperative diagnosis of complete urethral duplication in bladder exstrophy.
- Excision of the dorsal urethral plate and maintenance of the ventral urethra represent the optimal surgical approach.
- This management strategy results in favorable outcomes regarding continence and penile function.