Abstract
Objectives The objective of this study was to define anatomical and radiological features of
the so-called Y-type urethral duplication.
Methods The study included four male patients and one female patient with congenital connection
between the urogenital tract and the external anal orifice. Investigations included
renal sonography, urethrograms, and magnetic resonance imaging pelvis in the last
patient. The urethrograms of male patients were carefully reviewed, in addition to
available urethrograms of similar cases that could be obtained through searching the
literature.
Results Unlike cases of urethral duplication, the male patients had always a complete prepuce
and a functioning anterior urethra in 25%. The accessory uroanal channel had almost
always a constant origin from the posterior urethra. Some tension seems to be exerted
by the urethroanal tract pulling on and causing a kink in the posterior urethra. Management
was simple in patients without anterior urethral hypoplasia (one male and the female
patient). Both were treated by simple excision of the communicating ano-urogenital
tract through a perineal approach with an excellent outcome. Histopathological examination
of excised tracts revealed stratified squamous cell in the former and transitional
cell lining in the latter. In patients with hypoplastic anterior urethra, staged urethral
reconstruction was performed in two, and progressive dilatation of hypoplastic anterior
urethra was tried in the last patient.
Conclusion Several observations would support diagnosing the congenital connection between the
urinary tract and the external anal orifice in the male as a congenital fistula rather
than an accessory urethra. Confirming and accepting this information may have its
impact on changing the current surgical approach.
Keywords
duplication - urethra - urethroanal fistula - Y-type
