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Table of Contents
COMMENTARY
Year : 2012  |  Volume : 11  |  Issue : 3  |  Page : 190  

Urethral duplication


Department of Surgery, Bayero University, Kano and Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication5-Jun-2012

Correspondence Address:
Sani Alhasan
Department of Surgery, Bayero University, Kano and Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Alhasan S. Urethral duplication. Ann Afr Med 2012;11:190

How to cite this URL:
Alhasan S. Urethral duplication. Ann Afr Med [serial online] 2012 [cited 2020 Aug 5];11:190. Available from: http://www.annalsafrmed.org/text.asp?2012/11/3/190/96884

Urethral duplication is a rare lower urinary tract congenital anomaly with an incidence of 1:5.5 million but may be under-reported as it is not uncommon for it to be associated with other urogenital and cloacal abnormalities. [1]

The authors have presented yet another case with a mistaken initial diagnosis and were most daring to have undertaken such a case without a road map. In societies where circumcision is done for religious and traditional reasons, urethral duplication is bound to be confused with postoperative complication in the form of urethrocutaneous fistula.

Duplicated urethras occur as ventral and dorsal moieties orientated in the same sagittal planes in the majority of cases but other forms of presentation are with variable length and development of the non-dominant urethra to complete duplication of caudal structures in the Caudal Duplication Syndrome. [2]

The lack of a universally accepted classification is indicative of the incomplete understanding of its embryological etiology.

Diagnosis in infants and younger children needs a high index of suspicion as they are unlikely to complain or be observed during micturation. Hypospadiac patients and those with post-circumcision fistulae need attentive examination to rule out this anomaly.

The most appropriate investigation is micturating cystourethrography combined with retrograde urethrography in oblique positions. Magnetic resonance imaging (MRI) gives excellent pictures depicting the tissue plane and the relationship of the duplicated urethras with adjacent structures. [3]

Prenatal ultrasound of the fetal urinary tract initially suggests posterior urethral valves with distended bladder and ureteric reflux but Doppler color Doppler scan would reveal double stream when the fetus is sounded during micturition. [4]

Cystoscopic examination will reveal the extent of each urethra but may not be feasible for the accessory urethra due its smaller caliber.

Operative treatment is achieved preferably as a single stage but multistage procedures are employed in patients with more complex anatomy. Treatment should always be individualized. Minimally invasive treatment involves a urethra_urethrostomy excising their individual walls thereby joining the usually dominant larger caliber ventral to the smaller caliber dorsal urethra with satisfactory outcome. [5]

Surgical extirpation of the hypoplastic urethra to its proximal origin avoiding undue damage to neurovascular structures and the external urinary sphincter is achievable in almost all cases and long-term follow-up is mandatory so as to appreciate late post-operative complications.

 
   References Top

1.Boyd M, Woodward M, Lambert A. Case of a congenital urethral duplication being unmasked following circumcision for balanitis xerotica obliterans. Ann R Coll Surg Engl 2010;92:W556.   Back to cited text no. 1
    
2.Wisenbaugh ES, Palmer BW, Kropp BP. Successful management of a completely duplicated lower urinary system. J Pediatr Urol 2010;6:315-7.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Bhadury S, Parashari UC, Singh R, Kohli N. MRI in congenital duplication of urethra. Indian J Radiol Imaging 2009;19:232-4.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Chu AJ, Cho JY, Kim SH, Jun JK. Prenatal ultrasound findings of fetal urethral duplication. Ultrasound Obstet Gynecol 2010;36:652-3.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Yanai T, Kawakami H, Nango Y, Watayo H, Masuko T, Hirai M, et al. Minimally invasive repair of hypospadiac urethral duplication. Paediatr Surg Int 2011;27:115-8.  Back to cited text no. 5
    




 

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