Urethral duplication type influences on the complications rate and number of surgical procedures

Vol. 43 (6): 1144-1151, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0269


ORIGINAL ARTICLE

Roberto Iglesias Lopes 1,2, Amilcar Martins Giron 1, Marcos Figueiredo Mello 1, Cristovao Machado Barbosa Neto 1, Joana dos Santos 2, Paulo Renato Marcelo Moscardi 1, Victor Srougi 1, Francisco Tibor Denes 1, Miguel Srougi 1
1 Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil; 2 Division of Urology, The Hospital for Sick Children, University of Toronto, Canada

ABSTRACT

Introduction: Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies.

Material and Methods: We report thirteen boys with urethral duplication managed in our institution between 1988-2015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification.

Results: Mean patient’s age was 38.3±34.7 months (3-136 months). Mean follow-up was 7.7±3.4 years (3y8m-14y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%).

Required surgeries were 3.53±2.84 procedures per patient. Considering groups: Type IIA2 4.25±3.28, type IIA1 4±1.41 and type IA 1.33±0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2.

Conclusions: Patients with incomplete duplication (type I A or I B) can totally be as­ymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individual­ized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.

Keywords:  Surgical Procedures, Opera­tive; Urethra; complications [Subheading]

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