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A case of type 2A-Y urethral duplication mimicking perianal fistula
Özkan Herek, Nergül Çördük
Pamukkale University Faculty of Medicine Department of Pediatric Surgery, Denizli
Introduction:
Urethral duplication is a rare clinical condition. In type 2A-Y duplications, the open part of the penile urethra that opens to the perineum is rudimentary is very rare and less than 40 cases have been reported in the literature.
Case Presentation:
A male case of Syrian origin, aged eight years. He applied to our clinic with a complaint of discharge from a hole next to the anus. It was learned from the anamnesis that the family noticed this condition when he was 2 years old and that the clinics they applied to recommended surgery with the diagnosis of anal fistula, but the family did not accept it. The patient applied to our clinic because his complaints increased over the years. On physical examination a fistula mouth was detected in the lithotomy position at 01 o'clock in the region close to the anus. Fistulography was performed. In fistulography, it was determined that the fistula tract went to the bladder neck and there was retrograde opaque material passing into the bladder. Penil urethra was normal calibration Thereupon, it was diagnosed as a rare type of urethral fistula, Type IIA-Y urethral fistula. Surgical treatment was planned for the case. Cystoscopy was performed first in the operation. Although the apparent fistula mouth was not seen, abnormal tissue thickening was seen on the posterolateral surface of the posterior urethra. When methylene blue was injected from the fistula, it was determined that the methylene blue filled the bladder from this area. The bladder was catheterized with 10 Fr silicone foley. Following the suspension sutures placed at the fistula mouth, the duplicated urethra was released without disrupting its integrity. And the duplicated urethra was excised by tying it with silk sutures.
Conclusion:
Type 2A-Y urethral duplication fistula cases in which the penile urethra is normal are very rare. Perineal fistula mouths may open outside the midline around the anus. This may cause false diagnosis. Treatment is simpler than other Type 2A-Y and excision of the fistula is sufficient.