Classifications of Urethral Duplications

• 07 Jan 2021 09:12:55 AM
• |Pediatic Urology

Dear All,

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.

With warm Regards,

Venu

Comments(2)

• 

  Chandra Singh J

  12 Jan 2021 08:18:32 PM

  We encountered a boy who presented with features suggestive of bladder outlet obstruction, who we managed by urethrourethrostomy. Enclosing the link below. Reviewed him 8 years post op and he is doing extremely well.

  https://indianjurol.com/article.asp?issn=0970-1591;year=2016;volume=32;issue=2;spage=156;epage=158;aulast=Venkatramani
  

  
  

• 

  Venugopal P

  13 Jan 2021 10:54:05 AM

  Dear All,

  The link provided by Chandra on his case report published in IJU in 2016 is not opening on my computer. I am sending the link yet again for those interested in reading the case report.

  Urethral duplication with unusual cause of bladder outlet obstruction

  Vivek Venkatramani, Chandra Singh* et al, IJU, 32 (2): 156

  https://indianjurol.com/article.asp?issn=0970-1591;year=2016;volume=32;issue=2;spage=156;epage=158;aulast=Venkatramani (PDF available)

  https://indianjurol.com/temp/IndianJUrol322156-1847827_050758.pdf (may open)

  In the attachment provided I have provided 3 classifications namely Effman’s (1976) and Woodhouse (1979). The Concept of sagittal and Collateral Duplication was provided by Woodhouse and no mention regarding this is made by Effman in his classification though this has been considered as the popular classification.

  Mario Lima et al (2017) have brought out a comprehensive Classification of Urethral Duplications in Males and Females. Females are not given importance in Effman and Woodhouse Classifications. They have used Coronal in their classification avoiding the term Collateral which they felt was not appropriate. I would urge all to familiarize Mario Lima et al classification.

  With warm regards,

  Venu