title: The double urethra: revisiting the surgical classification.
abstract: OBJECTIVE
  The aim of this article was to describe our experience with 14 patients with double urethra.
  
  
  METHODS
  We retrospectively examined the patients' records including their clinical presentations, investigations, operative findings, and outcome. In addition to Effmann's classification, we used a newly proposed classification that depends on the orientation of the double urethral channels.
  
  
  RESULTS
  During the last 15 years, 18 patients were diagnosed to have double urethra at our pediatric surgical unit. We excluded four patients with 'Y-type' urethral duplication. The remaining 14 patients were divided into either sagittal or collateral duplication. Their age at presentation ranged from the neonatal period to 9 years. The sagittal urethral duplication included 12 male patients. All patients had two urethral channels, one above the other. The dorsal urethral channel was always characterized by poor function and ectopic course. The ventral channel was always the more functioning urethra, with a normal course from the urinary bladder to end either at an orthotopic meatus (subgroup A), or more proximally in a hypospadiac location (subgroup B). The collateral urethral duplication included two patients. Both patients were associated with duplication of the urinary bladder and the external genitalia as a part of caudal duplication syndrome. In this group, both urethrae had comparable function, lying side by side, and each draining a separate urinary bladder.
  
  
  CONCLUSIONS
  The double urethra is a diverse spectrum comprising different pathologies. Our proposed classification system of duplicated urethras is clinically relevant as it guides surgical management and allows prognostication of outcome.
authors.affiliation: Ain-Shams University, Lotefy El-Sayed, Abbassia, Cairo, Egypt.
authors.forename: Amr AbdelHamid
authors.initials: AA
authors.lastname: AbouZeid
authors.affiliation: Ain-Shams University, Cairo, Egypt.
authors.forename: Hesham Soilman
authors.initials: HS
authors.lastname: Safoury
authors.affiliation: Ain-Shams University, Cairo, Egypt.
authors.forename: Shaimaa AbdelSattar
authors.initials: SA
authors.lastname: Mohammad
authors.affiliation: Ain-Shams University, Cairo, Egypt.
authors.forename: Osama
authors.initials: O
authors.lastname: El-Naggar
authors.affiliation: Ain-Shams University, Cairo, Egypt.
authors.forename: Ahmed Medhat
authors.initials: AM
authors.lastname: Zaki
authors.affiliation: Ain-Shams University, Cairo, Egypt.
authors.forename: Tarek Ahmed
authors.initials: TA
authors.lastname: Hassan
authors.affiliation: Ain-Shams University, Cairo, Egypt.
authors.forename: Sameh Abdel
authors.initials: SA
authors.lastname: Hay
keywords: accessory urethra; epispadias; hypospadias; urethral duplication
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