UNLABELLED: Urethral duplication is a rare disease with various clinical expressions and treatments. The authors report 7 cases. MATERIAL AND METHODS: The authors retrospectively review 7 children with sagittal duplication of the urethra seen between 1995 and 2000. All children were investigated by ultrasonography of the urinary tract, retrograde cystography and voiding cystourethrography. RESULT: Except for one case of neonatal discovery, the mean age at diagnosis in the other six children was 4 years. In one case, the malformation consisted of blind incomplete urethral duplication (type I B) and urethroscopy confirmed the presence of an orifice distal to the urethral cap; symptomatic treatment was successful in this patient. Two children with complete urethral duplication with epispadias and two bladder orifices (type II A1) were successfully treated by resection of the supernumerary urethra. One child presented an U-shaped duplication (type II A2 "Y"). Unsuccessful opacification of the accessory urethra prior to its resection induced sclerosis and no flow with a follow-up of 24 months. Penile surgery was performed in two children with incomplete urethral duplication with only one vesical orifice (type II A2) transforming duplex urethra into distal bifid urethra after resection of the accessory urethra and its epispadic meatus. One child had a suspended duplication of the urethra with only one glandular meatus (type II B2) and a single vesical orifice. He was treated by endoscopic section of the urethral membrane separating the two urethras before their fusion in the bulbar urethra. With a mean follow-up of 36 months (range: 6 months to 4 years) no infectious or voiding complications were observed in these 7 children. CONCLUSION: Sagittal duplication of the urethra is a rare disease requiring precise anatomical and functional assessment. The ideal treatment for symptomatic forms is resection of the duplication without impairing sphincter function.
UNLABELLED: Urethral duplication is a rare disease with various clinical expressions and treatments. The authors report 7 cases. MATERIAL AND METHODS: The authors retrospectively review 7 children with sagittal duplication of the urethra seen between 1995 and 2000. All children were investigated by ultrasonography of the urinary tract, retrograde cystography and voiding cystourethrography. RESULT: Except for one case of neonatal discovery, the mean age at diagnosis in the other six children was 4 years. In one case, the malformation consisted of blind incomplete urethral duplication (type I B) and urethroscopy confirmed the presence of an orifice distal to the urethral cap; symptomatic treatment was successful in this patient. Two children with complete urethral duplication with epispadias and two bladder orifices (type II A1) were successfully treated by resection of the supernumerary urethra. One child presented an U-shaped duplication (type II A2 "Y"). Unsuccessful opacification of the accessory urethra prior to its resection induced sclerosis and no flow with a follow-up of 24 months. Penile surgery was performed in two children with incomplete urethral duplication with only one vesical orifice (type II A2) transforming duplex urethra into distal bifid urethra after resection of the accessory urethra and its epispadic meatus. One child had a suspended duplication of the urethra with only one glandular meatus (type II B2) and a single vesical orifice. He was treated by endoscopic section of the urethral membrane separating the two urethras before their fusion in the bulbar urethra. With a mean follow-up of 36 months (range: 6 months to 4 years) no infectious or voiding complications were observed in these 7 children. CONCLUSION: Sagittal duplication of the urethra is a rare disease requiring precise anatomical and functional assessment. The ideal treatment for symptomatic forms is resection of the duplication without impairing sphincter function.
Authors: Salvatore Arena; Carmela Arena; Maria Grazia Scuderi; Giuseppe Sanges; Francesco Arena; Vincenzo Di Benedetto Journal: Pediatr Surg Int Date: 2007-06-19 Impact factor: 1.827