Urethral duplication: Experience of four cases

Type IIB urethral duplication in adult: A case report

Urethral duplication are rare anomalies of the lower urinary tract consisting of partial or complete development of an accessory urethra that common in males than female. The exact embryological mechanism for this condition remain unclear, it is thought to relate to a disruption of development of the lateral folds of Rathke during hindgut development. There are 3 types based on Effman's classification. Diagnosis of urethral duplication, a genital examination has to performed and confirmed by micturating cytourethrography and retrograde urethrography. The authors presented a case of 67-year-old man complaining of dysuria, who was diagnosed with urethral duplication Effman Classification type IIB accompanied by bulbar urethral stricture and diverticula and multiple bladder diverticula after performing retrograde urethrography and micturating cystourethrography. This is an extremely rare type of duplication of the urethra (type IIB) with late presentation. Further study may be required regarding the surgical management.

Urethral Duplication Associated with Ectopic Scrotum: A Case Study

Urethral duplication is a rare anomaly with varying clinical manifestations. About 300 cases have been reported till date and are often associated with genitourinary (GU) and gastrointestinal (GI) tract anomalies. A 6-day-old neonate presented with an absent anal opening and a tiny perineal fistula having slight meconium staining. He did well after anoplasty. Low anorectal malformation (ARM) has been reported as the GI anomaly associated with urethral duplication. However, an ectopic scrotum as the principal GU tract anomaly associated with urethral duplication is being reported for the first time in literature with probable embryologic explanation. The GU tract anomalies were successfully repaired surgically later in infancy.

Urethral duplication associated with complex chordee: a narrative review of literature and report of a case

Background

Urethral duplication (UD) is reportedly rare. It is rarer in females. Knowledge on this anomaly comes from isolated report of cases. The aim of this review is to summarize information available on this anomaly thereby revealing gaps in knowledge, and to appropriately situate a recently managed case.

Methods

Publications on UD in English language from 2001 to 2021 were searched for in the literature. Of importance were age at presentation, class of UD, nature of associated penile deformity and other structural anomalies. Available information was used to synthesize opinions after descriptive analyses using SPSS® version 21 (IBM Co., Armonk, NY, USA). In addition, a recently managed case of UD was reported and appropriately situated in the discourse.

Result

In all, 115 articles met the inclusion criteria. Majority (75.7%) were individual case reports, while the rest were retrospective review of case series. These provided a total of 269 reported cases. Of this lot, 38 cases were excluded because they either had no Effmann’s class or were not described well enough for an Effmann’s class to be assigned. Ultimately, 231 cases formed the basis for this review. Male to female ratio was 12:1. Types III and IIB had more females. Types IIA 2 (26.0%), IIA 2 “Y” (26.4%) and IA (22.5%) were frequently reported. About 61.8% males and 68.4% females had no associated defects. Isolated dorsal chordee was prevalent (7.1%), especially among type IA (16.7%) UD. Reported in 10.4%, vesicoureteric reflux may not be attributable always to high pressure voiding.

A boy who presented at the age of 18 years with Effmann type IA UD and an associated complex chordee of the penile shaft was reported. The complex nature of the chordee adds to the challenge of explaining associated penile defects in UD.

Conclusion

UD is rare, but reported from all parts of the globe. There are a number of associated defects involving the external genitalia and other organs reported in UD in the male. The mechanisms of these defects are yet to be fully understood.

Partial urethral duplication in a cat

CASE DESCRIPTION

A 3-year-old neutered male domestic shorthair cat with a history of urethral obstruction was evaluated at a veterinary referral center for acute onset of hunched posture and signs of discomfort on being handled. No evidence of urethral obstruction was found; signs initially responded to medical management, but the cat was presented to the primary care veterinarian < 48 hours after the initial examination with signs suggesting urethral obstruction.

CLINICAL FINDINGS

No urinary calculi were detected radiographically. Attempted urinary catheter placement was unsuccessful, and the cat was returned to the referral center for evaluation and treatment of suspected urethral obstruction. Hematologic evaluation revealed hyperglobulinemia and leukocytosis; the cat was febrile, its prepuce was swollen, and its urinary bladder was soft but could not be manually expressed.

TREATMENT AND OUTCOME

A urinary catheter was placed; urinalysis revealed hematuria, leukocyturia, and bacteriuria. Medical management included analgesic, antimicrobial, urethral antispasmodic, and IV fluid treatment. Positive-contrast cystourethrography results were equivocal for a congenital anomaly versus urethral rupture. Contrast-enhanced CT revealed a sinus communicating with the dorsal aspect of the urethra, and urethral rupture was ruled out. Partial urethral duplication was confirmed surgically; perineal urethrostomy was performed, creating an opening to the accessory urethra, and the strictured orthotopic urethra was ligated. Four weeks after surgery, the cat was doing well.

CLINICAL RELEVANCE

This case highlighted the importance of advanced imaging to distinguish between urethral rupture and a congenital malformation in a cat with signs of lower urinary tract disease. This approach was pivotal to appropriate diagnosis and management and a favorable outcome for the patient.

Coexistent duplication of urethra and a refluxing ectopic ureter presenting as recurrent epididymo-orchitis in a child

Congenital anomalies of the kidney and urinary tract (CAKUTs) occur in 3-6 per 1000 live births, accounting for most cases of paediatric end-stage kidney disease.1 However, the molecular basis of CAKUT and anomalies of the external genitalia is poorly understood. We, herein, describe a case with left recurrent epididymo-orchitis with a coexistent urethral duplication and an ectopic ureter with an ipsilateral non-functioning kidney, which is, to the best of our knowledge, the first reported case of its kind. This case may bring about a paradigm shift in our comprehension of the development of the two entities. Understanding the pathogenesis may help develop preventive and renal preservation strategies. The Sonic hedgehog gene and bone morphogenetic protein 4 play crucial roles in preventing anomalies of the ureters and the external genitalia. In this article, we look at possible molecular pathways that could explain the synchronicity of this rare entity.

A case of urethral duplication arising from the posterior urethra to the scrotum with urinary stone in a 6-year-old male

Urethral duplication is a rare congenital anomaly. We report a 6-year-old male with type IIA2 (Y-type) using Effmann's classification. The accessory urethra, in which a urinary stone existed, arose from the posterior urethra to the scrotum. Because of recurrent urinary tract infection and urinary discharge from the accessory urethra, surgical removal of the accessory urethra through a scrotal incision was performed. At 7-month postoperative follow-up the patient was completely free from urinary incontinence and urinary tract infection.