Excision of a symptomatic unusual duplicated urethra in an adult male (original) (raw)

Journal of Clinical Urology, 2016

Abstract

A 52-year-old male presented with a history of recurrent urinary tract infections (UTIs). In the five months prior to presentation he had had five symptomatic UTIs. There was no history of lower urinary tract symptoms outside the episodes of infection. There was no prior history of traumatic urethral instrumentation. Uroflometry demonstrated a maximal flow of 19 ml/s and a post voiding ultrasound showed the bladder emptied completely. Two urethral lumens were demonstrated at flexible cystoscopy at the bulbar level (Figure 1), with one lumen ending blindly (accessory urethra), confirmed on urethrography (Figure 2). The patient elected to undergo excision of the accessory urethra. In lithotomy position, a vertical perineal incision was made and the bulbar urethra exposed. A rigid cystoscope was inserted to the point of bifurcation, where a marking suture was placed. The accessory urethral lumen was identified and marked (Figure 3), then opened vertically. The bladder was catheterized via the external urethral meatus and the duplicated urethra was excised. Urethral closure was undertaken using the Heineke–Mikulicz principle, with the soft tissue dead space closed by buttressing the peri-urethral corpus spongiosum. A catheter was left for 10 days. The postoperative retrograde urethrogram demonstrated no leakage and the patient successfully passed a trial without catheter. At six month follow-up there have been no further UTIs and the patient continues to void normally to completion on post void bladder scan. Histology confirmed an epithelium lined urethral lumen. The only residual problem is a degree of post-micturition dribbling.

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