Download PDF
Eur J Pediatr Surg 2016; 26(03): 245-251
DOI: 10.1055/s-0035-1551569
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Y-Type Urethral Duplication: A True Variant of the Anomaly or a Misnomer?

Amr A. AbouZeid
1   Department of Pediatric Surgery, Ain Shams University, Abbasia, Cairo, Egypt
,
Shaimaa A. Mohammad
2   Department of Radiodiagnosis, Ain-Shams University, Cairo, Egypt
,
Nehal A. Radwan
3   Department of Pathology, Ain-Shams University, Cairo, Egypt
,
Hesham S. Safoury
1   Department of Pediatric Surgery, Ain Shams University, Abbasia, Cairo, Egypt
,
Osama El-Naggar
1   Department of Pediatric Surgery, Ain Shams University, Abbasia, Cairo, Egypt
,
Sameh A. Hay
1   Department of Pediatric Surgery, Ain Shams University, Abbasia, Cairo, Egypt
› Author Affiliations
Further Information

Publication History

11 November 2014

29 January 2015

Publication Date:
29 May 2015 (online)

    Permissions and Reprints

Abstract

Objectives The objective of this study was to define anatomical and radiological features of the so-called Y-type urethral duplication.

Methods The study included four male patients and one female patient with congenital connection between the urogenital tract and the external anal orifice. Investigations included renal sonography, urethrograms, and magnetic resonance imaging pelvis in the last patient. The urethrograms of male patients were carefully reviewed, in addition to available urethrograms of similar cases that could be obtained through searching the literature.

Results Unlike cases of urethral duplication, the male patients had always a complete prepuce and a functioning anterior urethra in 25%. The accessory uroanal channel had almost always a constant origin from the posterior urethra. Some tension seems to be exerted by the urethroanal tract pulling on and causing a kink in the posterior urethra. Management was simple in patients without anterior urethral hypoplasia (one male and the female patient). Both were treated by simple excision of the communicating ano-urogenital tract through a perineal approach with an excellent outcome. Histopathological examination of excised tracts revealed stratified squamous cell in the former and transitional cell lining in the latter. In patients with hypoplastic anterior urethra, staged urethral reconstruction was performed in two, and progressive dilatation of hypoplastic anterior urethra was tried in the last patient.

Conclusion Several observations would support diagnosing the congenital connection between the urinary tract and the external anal orifice in the male as a congenital fistula rather than an accessory urethra. Confirming and accepting this information may have its impact on changing the current surgical approach.

Keywords

duplication - urethra - urethroanal fistula - Y-type
 

  • References

  • 1 Sánchez MM, Vellibre RM, Castelo JL, Arias MP, Sarmiento RC, Costa AR. A new case of male Y-type urethral duplication and review of literature. J Pediatr Surg 2006; 41 (1) e69-e71
    CrossrefPubMedGoogle Scholar
  • 2 deVries PA, Friedland GW. Congenital “H-type” ano-urethral fistula. Radiology 1974; 113 (2) 397-407
    CrossrefPubMedGoogle Scholar
  • 3 Effmann EL, Lebowitz RL, Colodny AH. Duplication of the urethra. Radiology 1976; 119 (1) 179-185
    CrossrefPubMedGoogle Scholar
  • 4 Bates DG, Lebowitz RL. Congenital urethroperineal fistula. Radiology 1995; 194 (2) 501-504
    CrossrefPubMedGoogle Scholar
  • 5 Rintala RJ, Mildh L, Lindahl H. H-type anorectal malformations: incidence and clinical characteristics. J Pediatr Surg 1996; 31 (4) 559-562
    CrossrefPubMedGoogle Scholar
  • 6 Stephens FD. Abnormal embryology - cloacal dysgenesis. In: Congenital Malformations of the Urinary Tract. New York: Praeger Scientific; 1983: 15-52
    Google Scholar
  • 7 Stephens FD, Donnellan WL. “H-type” urethroanal fistula. J Pediatr Surg 1977; 12 (1) 95-102
    CrossrefPubMedGoogle Scholar
  • 8 Al-Bassam A, Sheikh MA, Al-Smayer S, Al-Boukai A, Al-Damegh S. Congenital H-type anourethral fistula with severe urethral hypoplasia: case report and review of the literature. J Pediatr Surg 1998; 33 (10) 1550-1553
    CrossrefPubMedGoogle Scholar
  • 9 Kumaravel S, Senthilnathan R, Sankkarabarathi C, Bagdi RK, Soundararajan S, Prasad N. Y-type urethral duplication: an unusual variant of a rare anomaly. Pediatr Surg Int 2004; 20 (11–12) 866-868
    CrossrefPubMedGoogle Scholar
  • 10 Haleblian G, Kraklau D, Wilcox D, Duffy P, Ransley P, Mushtaq I. Y-type urethral duplication in the male. BJU Int 2006; 97 (3) 597-602
    CrossrefPubMedGoogle Scholar
  • 11 Arena S, Arena C, Scuderi MG, Sanges G, Arena F, Di Benedetto V. Urethral duplication in males: our experience in ten cases. Pediatr Surg Int 2007; 23 (8) 789-794
    CrossrefPubMedGoogle Scholar
  • 12 Ghadimi-Mahani M, Dillman JR, Pai D, Park J, DiPietro M. MRI of congenital urethroperineal fistula. Pediatr Radiol 2010; 40 (Suppl. 01) S1-S5
    PubMedGoogle Scholar
  • 13 Wagner JR, Carr MC, Bauer SB, Colodny AH, Retik AB, Hendren WH. Congenital posterior urethral perineal fistulae: a unique form of urethral duplication. Urology 1996; 48 (2) 277-280
    CrossrefPubMedGoogle Scholar
  • 14 Sinha S, Sen S, Chacko J, Thomas G, Karl S, Mathai J. Y-duplication of the male urethra: use of anterior anorectal wall for posterior urethral lengthening. Pediatr Surg Int 2006; 22 (6) 529-531
    CrossrefPubMedGoogle Scholar
  • 15 Prasad N, Vivekanandhan KG, Ilangovan G, Prabakaran S. Duplication of the urethra. Pediatr Surg Int 1999; 15 (5–6) 419-421
    CrossrefPubMedGoogle Scholar
  • 16 Mane SB, Obaidah A, Dhende NP , et al. Urethral duplication in children: our experience of eight cases. J Pediatr Urol 2009; 5 (5) 363-367
    CrossrefPubMedGoogle Scholar
  • 17 Podesta ML, Medel R, Castera R, Ruarte AC. Urethral duplication in children: surgical treatment and results. J Urol 1998; 160 (5) 1830-1833
    CrossrefPubMedGoogle Scholar
  • 18 Salle JL, Sibai H, Rosenstein D, Brzezinski AE, Corcos J. Urethral duplication in the male: review of 16 cases. J Urol 2000; 163 (6) 1936-1940
    CrossrefPubMedGoogle Scholar
  • 19 Gupta NP, Ansari MS, Aron M, Mandal S. Y duplication of urethra with complete atresia of the orthotopic channel: 1-stage reconstruction. J Urol 2000; 163 (3) 949-950
    CrossrefPubMedGoogle Scholar
  • 20 Wakhlu A, Wakhlu AK. Management of H-type urethral duplication. J Pediatr Surg 1998; 33 (8) 1238-1242
    CrossrefPubMedGoogle Scholar
  • 21 Passerini-Glazel G, Araguna F, Chiozza L, Artibani W, Rabinowitz R, Firlit CF. The P.A.D.U.A. (progressive augmentation by dilating the urethra anterior) procedure for the treatment of severe urethral hypoplasia. J Urol 1988; 140 (5, Pt 2) 1247-1249
    PubMedGoogle Scholar
  • 22 Murphy F, Puri P, Hutson JM, Holschneider AM. Incidence and frequency of different types, and classification of anorectal malformations. In: Hutson JM, Holschneider AM, eds. Anorectal Malformations in Children. Heidelberg, Berlin: Springer Verlag; 2006: 163-182
    Google Scholar
  • 23 Williams DI, Kenawi MM. Urethral duplications in the male. Eur Urol 1975; 1 (5) 209-215
    PubMedGoogle Scholar
  • 24 Coleman RA, Winkle DC, Borzi PA. Urethral duplication: cases of ventral and dorsal complete duplication and review of the literature. J Pediatr Urol 2010; 6 (2) 188-191
    CrossrefPubMedGoogle Scholar
  • 25 Hokama A, Myers NA, Kent M , et al. Esophageal atresia with tracheo-esophageal fistula (a histopathological study). Pediatr Surg Int 1986; 1 (2) 117-121
    CrossrefPubMedGoogle Scholar