title: Urethral duplication II-A Y type with rectal urethra: ASTRA approach and tunica vaginalis flap for first stage repair.
abstract: BACKGROUND
  Urethral duplication is a rare congenital anomaly affecting mainly boys. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. We present a patient 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 from the rectum and the ectopic urethra could be well identified by anal examination.
  
  
  METHODS
  Age at surgery was 13 months. The procedure consisted of an ASTRA (anterior sagittal trans-ano-rectal) approach for dividing the urethra and rectum and was successful to move the urethra up to the perineal area. The rectum was reconstructed and the patient placed into a lithotomy position. A urethral catheter inserted in the penile urethra oriented us were the atresic urethra in bulbar area started. The scrotum was opened in the middle and the distance between the two urethral stumps proximal and distal defined the extension of no urethral tissue that consisted of 5 cm. We opened the right scrotal space and a tunica vaginalis flap was obtained and attached to the bulbar tissue for a two-stage urethroplasty strategy.
  
  
  RESULTS
  Patient had a nice healing and the tunica vaginalis was nicely incorporated to the adjacent tissue, having the two urethral stumps well delineated.
  
  
  CONCLUSIONS
  ASTRA approach in combination with a two-stage urethroplasty with tunica vaginalis dorsal flap proved to be an excellent combination for a rare case of urethral Y duplication having the main urethra into the rectum.
authors.affiliation: Department of Urology, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil. macedo.dcir@epm.br
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
authors.forename: Atila
authors.initials: A
authors.lastname: Rondon
authors.forename: Herick
authors.initials: H
authors.lastname: Bacelar
authors.forename: Sergio
authors.initials: S
authors.lastname: Ottoni
authors.forename: Riberto
authors.initials: R
authors.lastname: Liguori
authors.forename: Gilmar
authors.initials: G
authors.lastname: Garrone
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
mesh_terms: D006801:Humans; D007223:Infant; D008297:Male; D012007:Rectum / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery