Various Types of Urethral Duplication Found in Boys

Hyeyoung Lee; Chang Hee Hong; Sang Won Han

doi:10.4111/kju.2008.49.7.659

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Lee, Hong, and Han: Various Types of Urethral Duplication Found in Boys

Original Article

Korean J Urol 2008;49(7):659-663.

Published online: 19 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.7.659

Various Types of Urethral Duplication Found in Boys

Hyeyoung Lee, Chang Hee Hong, Sang Won Han

From the Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea

Received 11 April 200816 May 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Urethral duplication is a rare congenital anomaly that can present in various clinical forms according to the plane and extent of duplication. Although some are associated with abnormalities of the external genitalia, others present as mild condition which is incidentally found. Nine cases of complete and incomplete types of urethral duplication have been reported in the Korean literature. We report the clinical presentation and management of four cases of various types of urethral duplication in boys.

Keywords: Congenital, Urethral diseases

REFERENCES

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4.Huang CC., Wu WH., Chai CY., Wu TC., Chuang JH. Congenital prepubic sinus: a variant of dorsal urethral duplication suggested by immunohistochemical analysis. J Urol. 2001. 166:1876–9.

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9.Berrocal T., Novak S., Arjonilla A., Gutierrez J., Prieto C., Urrutia MJ. Complete duplication of bladder and urethra in the coronal plane in a girl: case report and review of the literature. Pediatr Radiol. 1999. 29:171–3.

Fig. 1.

Patient 1 who presented with complete duplication of the bladder and urethra. (A) Urethral opening in mid-dorsum of the penis (black arrow) and indentation of the coronal glans. (B) Dorsal curvature at rest. (C) Magnetic resonance imaging showing fluid and air-filled accessory bladder (white arrow) anterior to the native bladder. (D) Excision of the dorsal accessory urethra. (E) Apparent dorsal curvature with artificial erection. (F) Correction of the dorsal curvature after ventral plication.

Fig. 2.

Narrow accessory dorsal urethra in patient 2 with prolene 2-0 inserted.

Fig. 3.

Patient 3 (A) concealed penis (B) accessory dorsal urethral meatus found in the dorsal glans when the foreskin was retracted for penoplasty (black arrow).

Fig. 4.

Patient 4 presenting (A) with a normal urethral orifice at the tip of the glans, as well as a (B) dorsal urethral opening at the dorsal penile base (black arrow).

Table 1.

Clinical data of patients with urethral duplication

Pt #	Age	Clinical presentation	Accessory urethra	Associated anomaly	Treatment	Type (Effmann classification)
1	10	Suprapubic pain & urethral pus discharge, dorsal curvature	Mid-dorsum of penis, patent upto accessory bladder	-	Excision of accessory bladder & urethra	Type III, complete duplication of bladder & urethra
2	5	Dorsal curvature	Mid-dorsum of penis, blind ending	-	Excision of accessory urethra	Type I, incomplete urethral duplication
3	2	Incidentally found accessory urethra	Dorsal glans, blind ending	-	Excision of accessory urethra	Type I, incomplete urethral duplication
4	12	Additional opening in dorsal penile base	Dorsal penile base, blind ending	-	Excision of accessory urethra	Variant of type I, congenital prepubic sinus

Table 2.

Effmann classification of urethral duplication³

Type	Description
I	Blind incomplete urethral duplication or an accessory urethra
IA	Common distal type in which an accessory urethra opens on the dorsal or ventral penile surface but does not communicate with the urethra or bladder
IB	Proximal type that may be difficult to differentiate from a urethral diverticulum or Cowper’s ducts in which an accessory urethra opens from the urethral channel and ends blindly in the periurethral tissue
II	Complete patent urethral duplication
IIA	2 meatus
IIA1	2 noncommunicating urethras arising independently from the bladder
IIA2	Second channel arising from the first independently courses into a second meatus
IIB	1 meatus
IIB1	Rare type in which 2 urethras arising from the bladder or posterior urethra unite into a common channel distally
III	Urethral duplication as a component of partial or complete caudal duplication

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