Abstract

INTRODUCTION

Urethral duplication is a very rare condition – only about 200 cases have been described in medical literature..This congenital anomaly is characterized by two urethras, which may be either partial or complete. One urethra is usually normal and the other is an accessory urethra. Accessory urethras may be present dorsal to, ventral to or next to the normal urethra. Rarely, accessory urethras may communicate with the prostatic ducts and seminal vesicles. When the accessory urethra is in the dorsal position, the external meatus can be epispadiac; if in the ventral position, the accessory urethra is usually hypospadiac, and the external urethra can open anywhere from the glans to the penoscrotal junction. The latter may resemble a congenital urethra–perineal fistula. In some patients, the accessory urethra may open into the anal canal or at the anorectal junction; this anomaly is referred to as an H-type fistula rather than an accessory urethra. Rarely, when there is no cutaneous or rectal communication, the accessory ventral urethra may form a cyst.The two duplicated urethras may lie side by side; in these cases, the duplication may be limited to the prostatic urethra. Urethral duplications can also occur with glandular or complete diphallus. The anomalies associated with urethral duplication are superior vesical fissure, bladder exstrophy, posterior urethral valves, imperforate anus, congenital urethral polyps and megalourethra of both channels. Most patients have no symptoms except for, perhaps, a double stream. Other presentations may be incontinence, urinary tract infections and bladder outflow tract obstruction.