Urethral duplication in male children: A study of 12 cases
Sung Ku Kang1, Jinu Kim1, Yong Seung Lee1
1Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Urethral duplication management varies by anatomical type. Individualized surgical strategies are crucial for optimal outcomes in patients with this congenital anomaly.
Area of Science:
- Pediatric Urology
- Congenital Anomalies
- Surgical Management
Background:
- Urethral duplication is a rare congenital anomaly.
- Surgical correction is often complex and requires tailored approaches.
Purpose of the Study:
- To detail surgical management experiences for urethral duplication.
- To correlate surgical techniques with anatomical classifications.
Main Methods:
- Retrospective review of 12 male patients (2005-2017).
- Utilized ultrasound, urethrography, cystoscopy, and voiding cystourethrography for evaluation.
- Classified cases using the Effmann classification.
Main Results:
- Diverse surgical techniques were employed based on Effmann type (I, II, III).
- Type I involved urethral excision or channel unification.
- Type II and III required more complex reconstructions, including urethral excision and buccal mucosa grafting.
Conclusions:
- Individualized surgical approaches are essential for urethral duplication.
- Prognosis depends on urethral duplication type and associated anomalies.
- Comprehensive workup and tailored surgical planning are critical.
Purpose:
To present our experience in urethral duplication focusing on detailed surgical management.
Methods:
We retrospectively reviewed the records of 12 male patients treated for urethral duplication between 2005 and 2017. Evaluations included ultrasound, retrograde urethrography, cystoscopy, and voiding cystourethrography.
Results:
The age at presentation ranged from birth to 11 years. All 12 cases were classified using the Effmann classification. Case 1-4 patients with type I underwent excision of the dorsal accessory urethra by stripping technique. In case 5 patient(type IA) with two adjacent apical urethras, the septum was opened to form a single channel. Case 6 patient with type IB underwent visual internal urethrotomy near bulbous urethra to combine urethra into one channel. Five patients classified as type II (one with a type IIA1, and four with type IIA2 urethras). Urethral duplication was incidentally found during epispadias repair in case 7 patient with type IIA1, which was corrected by ventral plication, and excision of the dorsal epispadial urethra with stripping technique just below pubic bone. Case 8 patient with type IIA2 also required dorsal urethral excision with stripping technique. The two Y-type patients (case 10, 11) underwent urethrourethrostomy with a single-stage buccal mucosa tube graft, followed by repetitive surgeries owing to urethral stricture. One type III patient presented with penile inflammation and suprapubic pain, and underwent excision of both the dorsal urethra and nonfunctional anterior bladder.
Conclusions:
Urethral duplication requires individualized surgical approaches based on the anatomical and functional characteristics. Because prognosis is variable depending on type and accompanied anomalies, these should be taken into account when planning a comprehensive workup and surgical management.
Level Of Evidence:
Level IV.
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