Working classification and the quest for an effective, reconstructive management strategy in Y duplication of male urethra.

INTRODUCTION: Y-duplication is a rare subtype of urethral duplication whose surgical correction has traditionally yielded less than satisfactory results. Herein we report 18 patients, 17 of whom have completed successful urethral reconstruction. MATERIALS AND METHODS: A retrospective analysis was done on 18 children who have undergone repair of Y-duplication urethra in two tertiary care institutes from 2013 to 2020. The various subtypes encountered were classified in order to develop a rationale for reconstruction based on the underlying pathology. The various modalities used for reconstruction and the outcomes of the repair were studied. All but one boy voided mainly via the posterior (ventral) channel opening in the ano-rectum or perineum. These boys had the urethral reconstruction incorporating the healthy proximal ventral urethra at its origin. Further reconstruction up to the glans tip depended on the degree of dorsal (orthotropic) urethral patency, which forms the basis of our classification into Types I (completely stenotic), II (penile urethra patent), III (penile and bulbar urethra patent) and IV (fully patent dorsal urethra). RESULTS: Reconstruction resulting in voiding via a glanular or coronal meatus was completed in 17 boys. One boy is awaiting further surgery while being dependent on Mitrofanoff CIC. While urethral continuity could be achieved using patent segments of native urethra alone into two boys (Types II and III), all other children needed a neo-urethral segment to replace (Type I) or supplement (Type II) the dorsal urethra. Neo urethra was constructed from a tubularized preputial island flap (n = 11), Monti tube constructed from ileum (n = 3) or sigmoid colon (n = 4). A perineal operative exposure alone sufficed in 9, while the rest required an additional trans pubic approach. The only boy with Type IV anomaly underwent excision of the ventral urethral limb. Three boys with initially elevated serum creatinine have normal levels after reconstruction. CONCLUSION: Successful reconstruction of boys with Y- duplication of the urethra entailed elucidation of anatomical variations, adequate operative exposure (trans pubic and/or perineal) and innovative utilisation of local and/or distant tissues (preputial island flap, ileal/sigmoid Monti tubes).

Urethral duplication in male children: A study of 12 cases.

PURPOSE: To present our experience in urethral duplication focusing on detailed surgical management. METHODS: We retrospectively reviewed the records of 12 male patients treated for urethral duplication between 2005 and 2017. Evaluations included ultrasound, retrograde urethrography, cystoscopy, and voiding cystourethrography. RESULTS: The age at presentation ranged from birth to 11 years. All 12 cases were classified using the Effmann classification. Case 1-4 patients with type I underwent excision of the dorsal accessory urethra by stripping technique. In case 5 patient(type IA) with two adjacent apical urethras, the septum was opened to form a single channel. Case 6 patient with type IB underwent visual internal urethrotomy near bulbous urethra to combine urethra into one channel. Five patients classified as type II (one with a type IIA1, and four with type IIA2 urethras). Urethral duplication was incidentally found during epispadias repair in case 7 patient with type IIA1, which was corrected by ventral plication, and excision of the dorsal epispadial urethra with stripping technique just below pubic bone. Case 8 patient with type IIA2 also required dorsal urethral excision with stripping technique. The two Y-type patients (case 10, 11) underwent urethrourethrostomy with a single-stage buccal mucosa tube graft, followed by repetitive surgeries owing to urethral stricture. One type III patient presented with penile inflammation and suprapubic pain, and underwent excision of both the dorsal urethra and nonfunctional anterior bladder. CONCLUSIONS: Urethral duplication requires individualized surgical approaches based on the anatomical and functional characteristics. Because prognosis is variable depending on type and accompanied anomalies, these should be taken into account when planning a comprehensive workup and surgical management. LEVEL OF EVIDENCE: Level IV.

Urethral Duplication in Children: Experience of Twenty Cases.

BACKGROUND AND OBJECTIVE: Urethral duplication is a rare congenital anomaly having multiple anatomical variants and varied presentations. Multiple surgical techniques have been described for this anomaly, and no surgical technique is ideal. The aim of this study was to present our experience of twenty cases of urethral duplication in the management of this anomaly. MATERIALS AND METHODS: Retrospectively over a period of 10 years from 2006 to 2016, records of all urethral duplications were reviewed. All available records were evaluated for clinical presentation, imaging studies (micturating cystourethrogram, retrograde urethrogram, ultrasonography, and cystourethroscopy), and classified according to the Effmann's classification. The intraoperative details, outcome, and follow-up (including cystoscopy and contrast studies) were noted. RESULTS: There were 20 patients of urethral duplications. Age of patients ranged from 3 months to 9 years with a mean age of 4.6 years. The details of management, outcome, and follow-up were obtained. CONCLUSION: Management varies with the symptoms and the severity of the anomaly. Y-type urethral duplication is more complex and challenging and requires extensive urethral reconstruction. Combined use of the bladder and buccal mucosa for reconstruction gives better results than bladder mucosa alone.

Persistent Urinary Incontinence After Nephrectomy: A Case of Inverted-Y Ureteral Duplication with Ectopic Ureteral Insertion into the Vagina.

Inverted-Y ureteral duplication is one of the rarest anomalies of ureteral branching. We encountered a 20-year-old female patient with persistent incontinence even after nephrectomy for ectopic ureteral insertion into the vagina. She had inverted-Y ureteral duplication between the bladder and vagina, and urine was being transported from the bladder to the vagina. To the best of our knowledge, this is a rare case of inverted-Y ureteral duplication with ectopic ureteral insertion into the vagina as well as the ureter into the bladder, which became apparent due to persistent urinary incontinence even after nephrectomy.

Laparoscopic management of obstructed partial duplex with Y ureteric configuration.

An 11-year-old girl underwent a laparoscopic upper-to-lower moiety ureteropyelostomy for lower moiety pelviureteric junction obstruction associated with Y ureteric duplication. She presented with left flank pain and was noted to be hypertensive with microscopic haematuria on admission. An abdominal ultrasound scan revealed a duplex left kidney with gross lower moiety pelvicalyceal dilatation. A subsequent MAG-3 scan demonstrated reduced differential function in the left lower moiety. A laparoscopic transmesocolic approach confirmed a dilated lower moiety pelvis and revealed the Y ureteric duplication. An upper to lower moiety ureteropyelostomy and insertion of a JJ stent is described in the accompanying video. The child was discharged home on the second day post operation. Postoperative imaging showed good decompression and improved differential function. The child has been completely well and normotensive at 2 years' follow-up.

A Case of a Double Gallbladder with Common Bile Duct Stones / 대한소화기내시경학회지

A double or bilobed gallbladder is a rare congenital anomaly, occurring at a rate of 1/4,000~5,000. We encountered a case of a double gallbladder that was diagnosed by an endoscopic retrograde cholangiogram. In view of the paucity of this anomaly, we report the case of a patient with a double gallbladder (Y duplication) accompanied by a common bile duct (CBD) stone. We also discuss the characteristics, classification, embryology and treatment of the double gallbladder.