Subpubic fistula: a urethral duplication

Letter to editor: One case of congenital dorsal penile cutaneous fistula

Congenital cutaneous fistula in the pubic area in infants and young children is a very rare congenital dysplasia disease, mainly manifested by abnormal punctiform opening near the midline of the area. What we are going to describe is a case of a 2-month-old boy with a congenital dorsal penile cutaneous fistula. At first, the main manifestation was pus at the opening of the fistula. The child recovered well after surgery without obvious complications.

Congenital prepubic urachal-cutaneous fistula

Congenital prepubic fistula is a very rare congenital anomaly that manifests as a punctiform opening in the midline of the pubic region. According to Campbell, congenital prepubic fistulae are duplicates of the dorsal urethra. Recent investigations have shown that this problem may have a complex etiology. We report a case of a congenital prepubic fistula in 2-month old female neonate, which manifested as a simple punctiform opening in the pubic region, with purulent secretion that resulted from applying pressure to the region. The surgical treatment was successful, and the infant had an uneventful postoperative course of healing.

Urethral duplication in girls: Three cases associating an accessory epispadiac urethra and a main hypospadiac urethra

INTRODUCTION

Urethral duplication is extremely rare in girls, with less than 40 cases reported so far. Most of them present as a prepubic sinus. Literature is scare regarding aetiology, classification and management in other forms. This study presents three cases of sagittal urethral duplication in girls presenting a main hypospadiac urethra and an accessory epispadiac urethra.

PATIENTS AND METHODS

Medical records were retrospectively reviewed of three girls with urethral duplication managed over a 30-year period at a single institution. Circumstances of diagnosis, management and outcomes were analysed.

RESULTS

The oldest case presented as a neonatal retrovesical mass with an accessory clitoral stream, whereas the two more recent cases presented with antenatal hydrocolpos and bilateral ureterohydronephrosis. Cases 1 and 3 had an incomplete duplication, while Case 2 had a complete form. In Case 3, the duplication was associated with a urogenital sinus and an anteriorly placed anus. Management involved resection of the epispadiac accessory urethra to achieve continence, with dilatation and/or mobilisation of the hypospadiac one. All girls are now aged >5 years old and are continent, and one is old enough to have normal menstruation. Renal function is normal in all. The summary table presents the schematic anatomical description as shown on micturating cystourethrogram and endoscopy, as well as the management for each patient.

DISCUSSION

Step-by-step management is necessary in urethral duplication. The neonatal emergency is to release the urinary tract compression by evacuating urinary retention or hydrocolpos. Later in infancy, decision has to be taken regarding the urethras. If the resection of the epispadiac accessory urethra seems acceptable to achieve continence, the attitude towards the hypospadiac channel is more controversial and should be individualised. Embryologic and aetiopathogenic pathways are still missing to uniformly characterise the malformation.

CONCLUSION

Paediatric urologists should remember that there is a wide spectrum of urethral duplication in girls, and that various presentations exist beside the more classic prepubic sinus.

Congenital prepubic sinus accompanied by prevesical abscess

Congenital prepubic sinus is an extremely rare anomaly. The etiology is uncertain and the anatomical features often differ from each other. We report a 22-year-old woman with a congenital prepubic sinus accompanied by a prevesical abscess. She was admitted to our hospital with high-grade fever and low abdominal pain. Computed tomography revealed a prevesical abscess. After treatment of the prevesical abscess, we completely excised the congenital prepubic sinus. To our knowledge, this is the first reported case that accompanied by prevesical abscess on a congenital prepubic sinus. Moreover, this case represents the oldest reported age of a patient with a congenital prepubic sinus.

Female double urethra: a case report

Female double urethra is a very rare anomaly, with less than 40 cases reported since 1970. Most reported cases of double urethra are in the sagittal plane and tend to be stenotic. We describe a 4-year-old girl with double urethra, which was not stenotic and was in the coronal plane. Double urethra should be excluded among other causes in any girl who is incontinent beyond the continence age.

Urethral duplication: a rare cause of urinary incontinence in a female child

Female urethral duplication is a rare congenital anomaly. We report a case of complete urethral duplication along with horseshoe kidney in a four-years-old female child presenting with incontinence since childhood.

Congenital prepubic sinus: is it a residual cloacal membrane and umbilicophallic groove?

We report two cases of congenital prepubic sinus (CPS) and discuss theories about its embryology and the etiology of its variants to improve the global understanding of this uncommon anomaly. Based on a review of the scant number of reported cases and our own experience, we postulate that CPS may be caused by a residual cloacal membrane and umbilicophallic groove and that its depth may determine the position of its ending.

Congenital prepubic sinus

Prepubic sinuses are rare congenital anomalies of the urinary tract. There have been few case reports in the literature. The authors describe 2 clinical cases of this entity. A review of the 20 cases previously reported, to clarify the anatomic features and the embryology of this infrequent congenital anomaly, also is reported. Furthermore, the authors propose to classify these lesions not as dorsal urethral duplications but as fistulas of the primitive urogenital sinus, with 3 anatomic types: high, toward the urachal remnant; middle, to the bladder; and low, reaching the urethra.

Urethral duplication and chromosomal translocation in a Swiss braunvieh heifer

As it was urinating, a six-month-old Swiss braunvieh heifer produced a second stream of urine from a fistula that opened on the ventrolateral margin of the left vulval lip. A catheter was introduced into this opening and passed easily into the bladder. Urethrography showed that the fistula joined the urethra in the mid-pelvic region and that a single canal originated from the bladder. Endoscopy confirmed this finding and also revealed a duplication of the vaginal portion of the cervix, a division of the cranial vagina by a septum and a fibrous band in the region of the hymenal ring. Cytogenetic examination revealed reciprocal translocation between chromosomes 20q23 and 22q23. A diagnosis of urethra duplex, duplication of the vaginal portion of the cervix and reciprocal autosomal translocation between chromosomes 20 and 22 was made on the basis of these findings.