Surgical management of a Type IIA-1 complete urethral duplication: A case report

Abstract

Ranger Kile*, Ruomei Wu and Matthew Timberlake

Urethral duplication is a rare congenital anomaly of the genitourinary tract with several possible anatomic variations and clinical presentations. Owing to its rarity and variability, best practices for diagnosis and intervention have yet to be defined. Management must therefore be individualized, focusing on preserving voiding and continence, preventing troublesome sequalae such as infection, and achieving normal cosmesis. Here we describe an asymptomatic 5-month-old boy with Effmann type IIA-1 complete urethral duplication confirmed by cystourethroscopy and retrograde urethrogram. The family was counseled on options of observation versus surgical excision, and opted for operative intervention. Open cystotomy was performed, with identification of the accessory urethra with retrograde instillation of methylene blue. The proximal portion of the urethra was then excised with multilayer closure. To avoid sphincteric injury, the prostatic/bulbar segments were not excised. The distal accessory penile urethra was then excised and a circumcision was performed. The patient experienced no postoperative complications. Our case illustrates a safe and effective surgical technique for localizing and excising a type IIA-1 urethral duplication while minimizing risk of injury to the sphincteric mechanism and neurovascular structures.