Classifications of Urethral Duplications
Urethral duplication is a rare anomaly of the lower urinary tract. Males are affected more than females.
The definition ‘urethral duplication’ includes various entities that differ in terms of clinical picture, anatomy and, therefore, management. Most patients are asymptomatic or they complain of the presence of a double urinary stream during micturition, but the range of described urinary symptoms is wide and includes incontinence, UTI, urinary retention or outflow obstruction. Symptoms are usually related to the continuity of the duplicated urethra and its relationship to the sphincter mechanism.
The anatomical variability and the rarity of the malformations have lead to classification problems.
The most used classifications (Effman and Woodhouse and Williams) were proposed in the 70s and refer exclusively to male forms. Effman does not define the plane of the duplication.
Woodhouse and Williams introduced the terms Sagittal and Collateral as they underline the embryological origin of the malformation. Sagittal duplications are the result of an altered midline migration of structures developed laterally and can be included in the epispadic-exstrophic complex; collateral duplications provide for the complete or incomplete development of two organs. The term collateral implies something that is secondary or accessory. Hence Mario Lima* et al (2017) introduced the terms Coronal and Sagittal. The lack of a uniformly accepted classification has complicated the proper choice of Surgical Treatment that may be necessary.
There is consensus that asymptomatic patients should be managed conservatively (Podesta et al 1998 and PW Ashish et al 2011). When required, surgery needs to be tailored to the single patient and individualized according to the anatomical features. Surgery is required in case of symptoms or cosmetic deformities, and it should be preceded by identification of the functional urethra that should be preserved. When possible, the aim is to restore anatomy, or at least to achieve satisfactory urinary continence.
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