Urethral duplication type influences on the complications rate and number of surgical procedures

Abstract

Introduction:Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies.Material and Methods:We report thirteen boys with urethral duplication managed in our institution between 1988-2015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification.Results:Mean patient's age was 38.3±34.7 months (3-136 months). Mean follow-up was 7.7±3.4 years (3y8m-14y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%).Required surgeries were 3.53±2.84 procedures per patient. Considering groups: Type IIA2 4.25±3.28, type IIA1 4±1.41 and type IA 1.33±0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2.Conclusions:Patients with incomplete duplication (type I A or I B) can totally be asymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individualized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.

<p>Complete Urethral Duplication: Case Report and Literature Review</p>

“…Lopes and his colleagues reported that the type of UD was associated with the number of surgeries needed and the postoperative complication rate. 17 Mane SB et al described a single-stage repair protocol in which the buccal mucosa forms a tube for urethroplasty in cases of Y-duplication and reported it achieved good final outcomes. 18 Mori et al described a case treated with complete excision of the accessory urethra from the normal urethra in a rare type IIA2 (Y-type) patient who had an accessory urethra that opened into the scrotum.…”

Urethral Duplication a Rare Cause of Even Rarer Dorsal Chordee

“…Not much is known about embryogenesis of urethral duplication and various hypothesis exist 5 . The spectrum of presentation can vary depending upon the type of anomaly according to Effmann classification system 6 . If we talk about chordee, it is more common on ventral side and often associated with hypospadia.…”

Duplicación de uretra: reporte de dos casos

“…11 En la duplicación uretral tipo I, la falla embriológica detectada es probablemente secundaria a la falla del desarrollo del tabique urorrectal. 10,[12][13][14] Algunos autores consideran que los casos con el tipo I (A o B) cuando son asintomáticos no tienen indicación quirúrgica. 14,15 Pero si presenta secreción se tendrá que realizar la exéresis de la uretra accesoria.…”

“…10,[12][13][14] Algunos autores consideran que los casos con el tipo I (A o B) cuando son asintomáticos no tienen indicación quirúrgica. 14,15 Pero si presenta secreción se tendrá que realizar la exéresis de la uretra accesoria. 10,16 Otra opción es una neouretroplastia descrita por Podesta.…”