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RARE VARIANTS OF URETHRAL DUPLICATION IN BOYS: CLINICAL CASES
Darya Tarasova 1, Dmitriy Morozov 2, Anna Chubykina 1, Eduard Ayryan 1, Maxim Ayrapetyan 3, Nikolay Khvatynets 4, Olga Sukhodolskaya 1
1 First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
2 Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University
3 Moscow Multidisciplinary Clinical Center
4 Children's City Clinical Hospital No. 9 named after G.N. Speransky
Objective: to present an examination algorithm and treatment tactics for patients with rare types of urethral duplication in boys
Materials and methods: patients with different types of urethral duplication are presented. Classification used is Effmann (1976) and Williams-Kenawi (1984).
Case №1. Patient of 11 years old. Complaints of urine leaking from the anus. When contrast is injected into the bladder (methylene blue), contrast is released in the perianal region.
Case №2. Patient of 8 months old, had an episode of acute paraproctitis that required emergency drainage, and after release from hospital suffered dysuria and unpleasant urine odor. During urethrocystography – contrast of the fistula passage.
Case №3. Patient of 17 years old, complaints of urine leakage from the accessory meatus on the dorsal surface of the penis, double jet injection.
Case №4. Patient of 13 years old, complaints of recurrent urinary tract infections, pyelonephritis. Both urethras shared common meatus on the ventral surface of the penis. The accessory urethra had the appearance of a blind diverticulum.
The diagnostic algorithm included: ultrasound of the urinary tract, excretory urography, microvascular cystourethrography, cystoscopy, MRI of the pelvic organs, rarely - CT of the pelvic organs, methylene blue sample, fistulography.
Results: the first two clinical observations are regarded as II2A Y-type of urethral doubling (Effmann ), the third observation is type IIA 1 (Effmann 1976), the fourth is type III (Effmann 1976) or as incomplete doubling of the urethra by type of hypospadias (Williams-Kenawi). Surgical treatment in all cases consisted of radical extirpation of the doubled urethra with plastic correction.
Conclusions: duplication of urethra is a complex congenital anomaly with variable clinical manifestations, which can cause difficulties in making a diagnosis. We consider it important to publish rare clinical observations in order to gain clinical experience in the treatment of this pathology.