Complete duplication of bladder and urethra in a sagittal plane in a male infant: case report and literature review

Bladder duplication in the male cat: the first case report in China

BACKGROUND

Bladder duplication is a rare congenital lower urinary tract anomaly disease characterized by the presence of two bladders, possibly with duplication of the urethra. This disease is rarely reported in cats. The clinical symptoms are commonly occult, with increased difficulty in making a definitive diagnosis, especially if there is no obvious urethral duplication. The diagnosis is typically based on radiographs and ultrasound, with computer tomography serving as a more advanced imaging diagnostic modality. Cases of duplicated bladders with accessory tubular tissues are even scarcer in both human and veterinary medicine.

CASE PRESENTATION

A 6-year-old male neutered cat was brought to the hospital because of vomiting and constipation. Cystography revealed increased soft tissue density of a fusiform structure in the lower middle abdomen. The purulent-filled cavitary structure and the accessory tubular structure were removed via surgery, and histopathological examination confirmed a double bladder with attached accessory tubular tissue. After antibiotic treatment, the cat recovered uneventfully.

CONCLUSION

This is the first case of bladder duplication in China and the first case of feline bladder duplication with tubular structure attachment in the world. This information will provide a reference for the diagnosis and treatment of similar cases in the future.

Urethral multiplicity in boys: systematic review of case reports and case series from the last 15 years

Introduction

Urethral multiplicity is a rare congenital anomaly characterized by the presence of two or more urethral channels. It is more common in males and can cause double urinary stream, incontinence, obstruction, and recurrent urinary infections. Diagnosis is difficult due to diverse clinical manifestations. Implementing an evidence-based treatment plan is challenging due to the need for more concise and informative summary publications. Our paper provides a comprehensive review of the management of this pathology and might serve as a valuable resource for pediatric urologists and specialists in the field.

Methods

A comprehensive search in four electronic databases, PubMed®, PubMed Central® (PMC), Scopus, and Clarivate Analytics's Web of Science (WoS), was conducted to identify case reports and series published between 2008 and 2023 on urethral multiplicities. The quality of the articles was assessed using qualified instruments. Covidence® tool-guided synthesis was followed by individual patient data extraction. Further classifications and analysis were made using Microsoft Excel®.

Results

Out of the 90 papers included in the review, 62 were case presentations, and 28 were case series. We found 250 boys with urethral multiplicity. Based on Effman's classification, there were 38 cases of type I (15.3%), 21 type IIA1 (8.4%), 55 type IIA2 (22.1%), 91 type IIA2Y (36.5%), 4 type IIB (1.6%), and 6 type III (2.4%) urethral duplications. There were 19 cases of prepubic sinuses (7.6%), 9 triplications (3.6%), and 6 unknown forms (2.4%). We have provided data for each type, including clinical presentation, investigations, surgical management, and outcomes.

Conclusions

Urethral multiplicities are a rare and varied group of malformations that require high-quality imaging examination for successful management. Treatment is specific to each patient and may depend on the surgeon's preference or skill.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID = CRD42023471685, identifier (CRD42023471685).

Bladder duplication in a patient with a persistent urogenital sinus: Case report and systematic review of the literature

Bladder duplication (BD) is a rare malformation that is often associated to other anomalies. We report a newborn diagnosed with BD in the sagittal plane, associated to persistent urogenital sinus (UGS), given the opening of the vagina immediately below the bladder neck. It is the fourth time this association is reported. Surgical repair was made: both bladders were joined, the common channel was left as urethra and the vagina was descended with a vaginoplasty with an intestinal segment. She also presented an anterior anus, that required posterior mobilization. The patient is currently 3 years old with good sphincter control.

Sagittal septum duplication of bladder and duplication of posterior urethra combined with congenital megacolon: a case report and literature review

BACKGROUND

Duplication of the bladder with duplication of the posterior urethra is a relatively rare congenital malformation. Cases of sagittal septum duplication of the bladder with duplication of the posterior urethra have rarely been reported. Furthermore, the combination thereof with congenital megacolon is rare.

CASE PRESENTATION

A 21-year-old male was admitted to our hospital because of frequent urination for two months. He presented to another hospital first with frequent urination and underwent computed tomography (CT) and testicular biopsy. Anti-inflammatory therapy was administered by the doctor to the patient. For further diagnosis and treatment, the patient went to the outpatient department in our hospital on June 6, 2022. After admission, the patient underwent ultrasound, CT, MRI, cystoscopy, and other related examinations and tests. The examination results suggested that the patient had duplication of the bladder with duplication of the posterior urethra. In addition, the patient's mother reported that he had suffered from long-term constipation with abdominal distension before the age of 5 years. At the time, he was admitted to the local hospital and was diagnosed with congenital megacolon based on the relevant examinations. After the patient was diagnosed with duplication of bladder and urethra, the doctor recommended surgical treatment to the patient. However, he considered that he only had frequent urination symptoms, and chose conservative treatment rather than to undergo surgical treatment. Thus, the doctor prescribed anti-inflammatory treatment. Four months later, the patient reported that frequent urination symptoms persisted, and was also considering fertility-related problems. The outpatient follow-up will be continued.

CONCLUSIONS

In this article, we summarize the imaging findings of duplication of the bladder with duplication of the posterior urethra and propose the advantages and disadvantages of each type of imaging examination. We also review the relevant literature on cases of bladders with duplication of the posterior urethra. The related differential diagnosis is summarized, and the significance of guiding clinical treatment and diagnosis is discussed.

Bladder triplication associated with exstrophy variant

A one-day old full-term female neonate presented with a duplicate bladder and exstrophy variant including a patch of exstrophic or ectopic mucosa, duplicate vagina, uterus, and two complete bladders. We report on the surgical management performed in this case and functional urinary results based on a synchronous urodynamic study of the duplicate bladders. To our knowledge, the occurrence of duplicate bladder exstrophy variant with complete urinary continence has not been previously reported.

A Triplicated Bladder with Diphallia; Rare Variant of Duplicate Exstrophy

Background

Exstrophy variants are well described urologic anomalies. They are characterized by atypical anatomical and physical findings than those found in patients with classic bladder exstrophy and epispadias malformation. The combination of these anomalies with duplicated phallus is a rare occurrence. Here we present a neonate with a rare form of exstrophy variant associated with penile duplication.

Case Summary

One day old male neonate who was born at term was admitted to our neonatal intensive care unit. He had lower abdominal wall defect and open bladder plate with no visible ureteric orifices. There were two completely separate phalluses with penopubic epispadias and urethral orifices draining urine. Both testes were descended. Abdominopelvic ultrasound showed normal upper urinary tract. He was prepared and operated with intra operative finding of complete bladder duplication in the sagittal plane and each bladder has its own ureter. The open bladder plate which had no connection with both ureters and urethras was excised. The pubic symphysis was approximated without osteotomy and abdominal wall was closed. He was immobilized with mummy wrap. He had uneventful post-operative course and was discharged on the 7th post-operative day. He was evaluated on the 3rd month post operatively and he was thriving well with no complications.

Conclusion

The occurrence of a triplicated bladder along with diphallia is an exceptionally rare urologic anomaly. As a number of variations are possible in this spectrum, the management of neonates with this anomaly should be individualized.

A Rare Case of Urogenital, Pelvic, and Tail Duplication in a Dog

We describe a case of congenital duplication involving urogenital organs, pelvis and tail in a dog diagnosed by ultrasound scanning, retrograde urethrocystography, and excretory urography. Left nephrectomy, cystectomy, urethral resection, orchidectomy, penectomy, and caudectomy were the treatment options for this case. No spine or intestinal alteration was observed by radiography. After the surgery, the patient condition was assessed for one year. No significant changes were observed in ambulation or in laboratory test results during this period, including normal urination. The patient is currently 6 years old, and is in good condition and with quality of life.

Bilateral hydroureteronephrosis: A neonatal presentation of bladder duplication

In a male neonate with bilateral hydroureteronephrosis, the most common surgical diagnosis is posterior urethral valves. This case report describes a male infant with the same presentation, but caused by a very uncommon congenital anomaly. The summation of different imaging modalities allowed a multidisciplinary team of colleagues to define the anatomy: bilateral duplex kidneys draining into separate urinary bladders. Only one of the bladders had an outlet, hence the obstructive uropathy to the right kidney led to total loss of function. The distended tortuous ureters produced a mass effect at presentation. This case acts as a reminder that complex congenital anomalies can mimic the presentation of more common conditions, and that they often require input from various specialists to diagnose the condition and guide its management.

Bladder Duplication - A Case Series

OBJECTIVE

To describe 5 cases with complete urinary bladder duplication, their associated conditions, and their respective treatment. Urinary bladder duplication is an extremely rare congenital anomaly of the urinary system. So far about 70 cases have been published in the English literature, most of them as case reports and a few case series.

METHODS AND RESULTS

All consecutive patients with bladder duplication treated at our institution between 2000 and 2015 were included. Patient records were retrospectively analyzed, and 5 patients with urinary bladder duplication were identified (see Summary Figure). Two patients were male. All duplications were recognized by health care providers. In 1 case recognition was prenatal (MRI in utero at 22 weeks of gestation), the latest recognition was at 12 months of age. A voiding cystourethrography was performed in 4 patients to confirm the diagnosis. In 4 patients the bladder duplication could be classified according to Abrahamson with 3 complete reduplications and one complete sagittal septum. All patients suffered from associated congenital diseases, but only one patient had urinary tract infections. Surgical treatment was only performed in one patient. Median follow-up was 34 months.

DISCUSSION

Urinary bladder duplications reflect extremely seldom disorders that are almost always associated with other congenital anomalies. Treatment depends on patients' symptoms and associated conditions and hence needs to be individualized to each patient.

Pseudodiphallia: a rare kind of diphallia: A case report and literature review

RATIONALE

Pseudodiphallia, as a rare kind of diphallia, which is characterized by a small accessory penile-like tissue without a normal penile anatomy structure. Only a few cases have been reported. Here, we report a case of pseudodiphallia with phimosis and bilateral extrarenal pelvis.

PATIENT CONCERNS

A 23-year-old male visited our hospital with a complaint of external genitalia malformation. Physical examination revealed a normal-sized penis with phimosis, and an extra half glans horizontally attached to the right side of the normal glans penis is visible after completely retracting the foreskin. The CT urography showed a bilateral extrarenal pelvis, and no other abnormalities were found in the kidneys, ureter, bladder, and vertebral bodies.

DIAGNOSIS

Based on the physical examination and the CT urography results, the 23-year-old male was diagnosed with Pseudodiphallia.

INTERVENTION

Excessive penile tissue was resected, and a foreskin circumcision operation was performed under general anesthesia.

OUTCOMES

The patient recovered smoothly without complications (no infection, hematoma, or wound dehiscence) after surgery. At 6 months follow-up, the patient was content with the external genitalia's appearance, and the urination and erectile function were normal.

LESSONS

Pseudodiphallia is a rare kind of diphallia, and this is the first report on pseudodiphallia with a bilateral extrarenal pelvis. CT urography can be used to assess the associated internal anomalies before surgery.

Laparoscopic excision of complete bladder duplication in a 1-year-old male

OBJECTIVE

Complete bladder duplication is a male predominant rare congenital malformation usually diagnosed at birth. Owing to the rarity of this anomaly, only few reports have discussed the surgical approach for this condition, with the open approach for excision being the most common. We hereby present a video of a laparoscopic resection of complete bladder and urethral duplication in a 1-year-old male.

METHODS

The patient presented to our clinic with a red mucosal tissue protruding from a cutaneous opening at the dorsal base of the penis that has been present from birth. A normally located and functioning bladder and urethra were present. During work-up, a cystic mass located above the bladder was discovered in imaging examinations. No other anomalies were found. After a shared decision process, we performed a laparoscopic transperitoneal bladder duplication excision during which the accessory urethra and duplicated bladder were removed with preservation of the adjacent normal urethra. The patient had an uneventful recovery with excellent cosmetic results.

CONCLUSION

The minimally invasive approach can be utilized for treatment of complex urinary anomalies in young children.

Hindgut Duplication: A Unique Case of Six Perineal Openings

Complete hindgut duplication is a rare and intriguing entity, often coupled with genitourinary abnormalities and neural tube defects. The diagnosis demands a thorough clinical exam and radiological workup. Timely recognition and expeditious treatment of these patients can lead to a better quality of life. We present a case of a 10-month-old female with complete hindgut duplication and associated genitourinary duplication treated with surgical intervention.

Diphallia with associated anomalies: a case report and literature review

Diphallia or penile duplication is an extremely rare congenital anomaly. It occurs once in every 5.5 million live births. The extent of penile duplication and the number of associated anomalies vary greatly, ranging from a double glans from a penis with no associated anomaly up to complete penile duplication associated with multiple anomalies. Here, we report a 12-year-old boy with complete bifid diphallia associated with bifid scrotum, epispadia, and pubic symphysis diastasis along with a review of the articles pertaining to this anomaly.

Complex genitourinary duplication affecting neurourologic and urodynamic findings: report of a case and review of the literature

BACKGROUND

Complete duplication of the bladder and urethra is a rare congenital anomaly and usually occurs in association with other organ anomalies. We report a case of complete bladder duplication associated with multiple non-genitourinary anomalies.

CASE

A 10-year-old girl presented with urinary incontinence and recurrent episodes of febrile urinary tract infections. Simultaneous right and left bladder urodynamic study was performed and revealed bilateral decreased bladder compliance associated with hyperreflexia. The patient underwent reconstructive surgery with combination of the 2 bladders and closure of the right incompetent bladder neck.

SUMMARY AND CONCLUSION

Management of bladder duplication is directed towards creating an unobstructed urinary tract, preventing infections, and achieving urinary continence. Neurourologic and urodynamic assessment is of utmost importance especially when concomitant spinal anomaly exists. Furthermore, these patients should be observed lifelong as alteration in bladder function may occur.

First case of complete bladder duplication in the coronal plane with concomitant duplication of the urethra in an adult male

Duplication of the lower urinary tract is a very rare congenital anomaly which is diagnosed either at birth or during early childhood. These rare malformations are most of the times accompanied by other concomitant anomalies and are therefore diagnosed immediately after birth. In some even rarer cases there are no concomitant anomalies and symptoms thus leading to a diagnosis later in childhood. This is the first case in the literature of complete bladder duplication in the coronal plane with concomitant duplication of the urethra and no other associated anomalies in a 52-year-old male who remained asymptomatic and therefore undiagnosed for more than 5 decades.

Endourological management in a newborn with incomplete bladder duplication

We report an unusual case of a newborn with incomplete bladder duplication and a complete sagittal septum. This malformation was associated with dysplasia of the right kidney, right cryptorchidism, single urethra, and no other genital or gastrointestinal anomalies. At birth, we found severe ureterohydronephrosis in a solitary left kidney caused by the collapse of the left bladder when the right bladder was filled. We performed a neonatal puncture of the bladder septum. At 3 months of life, the patient underwent complete resection of the septum by cystoscopy with monopolar electrocautery. There are no previously reported cases of a newborn with obstructed uropathy. This is the first reported case of incomplete bladder duplication with endourological management.

Incomplete transverse vesical septum: An unusual congenital anomaly

A rare case of incomplete transverse vesical septum with urinary tract tuberculosis is being reported. A 52-year-old male presented with lower urinary tract and systemic symptoms. On investigation he had anemia, leucocytosis, and high serum creatinine. On cystopanendoscopy, there was a transverse ledge of tissue connecting the two lateral walls of the bladder approximately 4 cm proximal to the bladder neck dividing the caudal vesical cavity into anterior and posterior parts. Also, the left ureteric orifice had double barrel look. To our knowledge this is the first ever reported case of incomplete transverse vesical septum.

Complete bladder and urethral duplication with normal urodynamic function associated with visceral sequestration

Complete bladder and urethra duplication is an extremely rare condition. It can occur in the sagittal or coronal plane, depending on the axis of the septum. Most cases are associated with other congenital defects. We present a case of complete duplication of the bladder and urethra in the sagittal plane with normal urodynamic function associated with bowel sequestration.

Complete Duplication of Bladder, Urethra, Clitoris and Vagina Associated with Bilateral Ureteral Reflux in an Old Female Patient: Unique Case

Complete duplication of the bladder, urethra, vaginal and clitoris is an extremely rare congenital anomaly that is usually diagnosed at pediatric age. We report an unusual case of a complete bladder, vaginal, clitoris and urethra duplication occurred in an old female patient (81 years old). This case highlighted the fact that an anatomical anomaly should be considered in all patients with persistent urinary tract problems, especially in old women, due to patients’ reluctance to consult physicians for this kind of problem.