A 15-year-old male presented with a history of post micturition dribbling and 'enuresis'. He had no medical comorbidity nor any erectile dysfunction. His referral letter incorrectly assessed him as having a normal examination. However, on penile examination, a second urethral meatal opening 10 mm lateral to the meatus on the glans was observed (Figure 1A). No other abnormality was found on examination. A voiding cystourethrogram (VCUG) was performed, which demonstrated a double urethra exiting from the membranous urethra (Figure 1B).This anomaly was also defined using pelvic magnetic resonance imaging (MRI). For better definition of the duplicate urethra, prior to MRI the duplicate urethral opening was cannulated with a ureteric catheter (Axxcess TM Catheter, Boston Scientific, Marlborough, MA 01752-1234, USA).For stability and orientation of the penis during the study, the glans and penile shaft were secured in the midline to the lower abdominal wall, using an adhesive dressing.The MRI study confirmed a urethral duplication, within the right corporal body, in the coronal plane (Figure 2A). On cystoscopy the urethral ostium was seen, and a guide wire was advanced through the ostium of the duplicate urethra, exiting from the duplicate urethral meatus (Figure 2B). Despite adequate counselling, the patient Summary This report describes an isolated urethral duplication in the coronal plane in a child referred with primary 'enuresis'. This presentation is unique because duplications usually occur in the sagittal plane. In patients with suspected urethral duplication, magnetic resonance imaging in conjunction with catheterisation of the distal duplicate opening accurately delineates the abnormality, so that individualised treatment strategies can be considered.

Background The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful. Objectives We aimed to review the role of the ‘ideal’ ratio on predicting residual PUV post-ablation. Methods A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included ‘Urethral Ratio and Posterior urethral valve ablation’. All cited reference lists were further evaluated for additional inclusive studies. Results Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 ( p = 0.001), 2.5–3 and 3.5. Conclusion Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2–3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.