Y-type urethral duplication in children: Management strategy at our center

• Main Authors: Sunita Singh (Author), Jiledar Rawat (Author)
• Format: Book
• Published: Wolters Kluwer Medknow Publications, 2013-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 0971-9261; 1998-3891; 10.4103/0971-9261.116042
• Keywords: Anourinary fistula; perineal urethrostomy; rectourinary fistula; urethral duplication; Y-type urethral duplication; Pediatrics; RJ1-570; Surgery; RD1-811
• Source: Journal of Indian Association of Pediatric Surgeons, Vol 18, Iss 3, Pp 100-104 (2013)

Aims: Report of seven children with Y-type urethral duplication (YUD). Materials and Methods: (A) Four staged operations were performed in patients having extensive perineal dissection (for rectourinary fistula separation and anterior mobilization of ventral urethra (VU)), tension rectocutaneous anastomosis, and children who were not toilet trained). These stages are (1) diversion sigmoid colostomy with anterior mobilization of VU as perineal urethrostomy via anterior sagittal approach; (2) Orthotopic urethral (OU) reconstruction; (3) anastomosis of OU and perineal urethra; (4) colostomy closure with management of complications. (B) The patients having VU onto the perineum underwent single stage urethral reconstruction. Results: The VU was urethrorectal/urethroanal in five and urethroperineal in two. Low anorectal malformation and upper urinary tract anomalies were present in 57.1% (4/7) and 14.7% (1/7) patients, respectively. Buccal mucosa free graft, transverse inner preputial flap, and perineal skin were tubularized for OU reconstruction. Mean age at 1 st , 2 nd , 3 rd , and 4 th surgery was 5 ± 0.78, 28 ± 0.78, 36 ± 0.78, 49 ± 0.78 months respectively. Three patients needed surgery for complications (urethrocutaneous fistula in two and urethral diverticulum in one) in a mean 3.12 ± 0.34 years of follow-up. Final uroflowmetry and fecal continence were good in all patients. Conclusions: The YUD is a difficult entity to manage. Although, staged procedure appears to be time consuming, but good and promising results can be achieved by staging the procedure.