Isolated coronal urethral duplication in an adolescent presenting with enuresis

Abstract

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.