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19–22 APRIL, 2017, BARCELONA, SPAIN
16:38–16:43
S11-9 (VP)
★
Y-TYPE URETHRAL DUPLICATION WITH RECTAL
IMPLANTATION OF THE URETHRA. WHICH IS THE BEST
APPROACH?
Antonio MACEDO JR
1
, Jorge ANTONIO POMPERMAIER
2
, Maria Isabel SILVA
3
,
Sérgio LEITE OTTONI
2
, Marcela LEAL DA CRUZ
2
, Gilmar GARRONE
2
and Riberto LIGUORI
2
1) Federal University of São Paulo, Departament of Pediatrics, São Paulo, BRAZIL - 2) CACAU - Centro de Apoio
a Criança comAnormalidade Urológica, Núcleo de Urologia Pediátrica - NUPEP, São Paulo, BRAZIL - 3) CACAU -
Centro de Apoio a Criança comAnormalidade Urológica, NUPEP - Núcleo de Urologia Pediátrica, São Paulo, BRAZIL
PURPOSE
Urethral duplication is an uncommon lower urinary tract anomaly, with multiple anatomical variants
described. Generally, the duplication develops in the sagittal plane and the accessory urethra may
run dorsally or ventrally to the orthotopic one. The aim of this video was to demonstrate the use of
the ASTRA (anterior sagittal transanorectal approach) in a case of Y-type urethral duplication (type
IIA 2).
PATIENTS AND METHODS
We report a case of a 5-months-old boy with urethral duplication in which the orthotopic urethra was
patent in the penile segment but atresic in the bulbar and prostatic segment. The patient had urinary
flow per anus and minimal dribbling through the orthotopic urethra since birth. The ectopic urethra
could be well identified by anal examination. We performed a combined cystoscopy with retrograde
urethrogram and managed to catheterize the dysplastic urethra with a guided-wire that showed
ectopic implantation in the prostatic urethra, below the bladder neck. The procedure consisted of an
ASTRA (anterior sagittal trans-anorectal) approach to divide the urethra and rectum and managed
to successfully reposition the urethra at the perineal area and to create an urethrostomy.
RESULTS
The postoperative hospital-stay was 1 day and follow-up is 6 months. No intestinal complaints and
other complications were seen.
CONCLUSIONS
ASTRA proved to be an excellent approach for Y-urethral duplication in which the main urethra was
placed into the rectum. We believe from our previous experience, that further efforts to reconstruct
the urethra irrespectively of one or two-stage settings are not fruitful and parents should be advised
to keep the perineal urethrostomy as the definitive procedure.
16:43–16:58
Discussion