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Urethral duplication in children: surgical treatment and results
M L Podesta1, R Medel, R Castera
1Department of Surgery, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.
Insights
Surgical correction of urethral duplication in boys, a rare congenital anomaly, involved different techniques based on duplication type. Most patients achieved normal voiding, demonstrating successful management of this complex condition.
Area of Science:
- Pediatric Urology
- Congenital Anomalies
- Surgical Reconstruction
Background:
- Urethral duplication is a rare congenital anomaly.
- Incomplete sagittal duplication presents unique challenges in pediatric patients.
Purpose of the Study:
- To report the clinical presentation, imaging findings, and surgical treatment outcomes.
- To evaluate surgical techniques for incomplete sagittal urethral duplication in boys.
Main Methods:
- Seven boys with incomplete sagittal urethral duplication were treated.
- Group 1 (hypospadias) underwent 1-stage urethroplasty.
- Group 2 (Y duplication) underwent 2-stage reconstruction with scrotal tubed neourethra.
Main Results:
- Six of seven patients achieved spontaneous voiding through a normal meatus.
- Complications included urethrocutaneous fistula (1/5) and meatal stenosis (1/2).
- One patient required intermittent catheterization due to neourethral irregularities.
Conclusions:
- Surgical management of urethral duplication requires tailored approaches.
- Combined surgical techniques can effectively correct severe urethral malformations.
- Further research is needed to establish ideal surgical protocols.
Purpose:
Urethral duplication is a rare congenital anomaly. We report the clinical presentation, imaging findings and surgical treatment in 7 boys with incomplete sagittal duplication of the urethra.
Materials And Methods:
Duplication involved hypospadias in 5 cases (group 1) and a bifid urethra with an accessory preanal tract (Y duplication) in 2 (group 2). Group 1 was treated with 1-stage urethroplasty, including marsupialization of the dorsal orthotopic urethra, ventral-to-dorsal urethrourethrostomy and penile island flap onlay repair to cover the open dorsal urethra. In contrast, group 2 was treated with 2-stage urethral reconstruction with detachment and mobilization of the accessory preanal branch in association with a scrotal tubed neourethra followed by urethroplasty, as in group 1. In all cases the dorsal penile urethra was located between the corpora cavernosa and surrounded by the tunica albuginea.
Results:
A urethrocutaneous fistula developed in 1 of the 5 group 1 patients. In group 2, 1 patient had recurrent penoscrotal meatal stenosis after the 1-stage procedure and 1 had a urethral diverticulum with calculi at the scrotal tubed neourethra 7 years after urethral reconstruction. Six of the 7 patients now void spontaneously through a meatus located normally at the tip of the glans. The remaining patient with a neurogenic bladder is on intermittent catheterization via appendicovesicostomy due to difficult catheterization of the irregular and sensitive neourethra.
Conclusions:
While the ideal surgical management of urethral duplication anomalies remains uncertain, we used a combination of surgical techniques to correct this severe malformation.