title: Urethral duplication type influences on the complications rate and number of surgical procedures.
abstract: BACKGROUND
  Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies.
  
  
  METHODS
  We report thirteen boys with urethral duplication managed in our institution between 1988-2015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification.
  
  
  RESULTS
  Mean patient's age was 38.3±34.7 months (3-136 months). Mean follow-up was 7.7±3.4 years (3y8m-14y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%). Required surgeries were 3.53±2.84 procedures per patient. Considering groups: Type IIA2 4.25±3.28, type IIA1 4±1.41 and type IA 1.33±0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2.
  
  
  CONCLUSIONS
  Patients with incomplete duplication (type I A or I B) can totally be asymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individualized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.
authors.affiliation: Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil.|Division of Urology, The Hospital for Sick Children, University of Toronto, Canada.
authors.forename: Roberto Iglesias
authors.initials: RI
authors.lastname: Lopes
authors.affiliation: Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil.
authors.forename: Amilcar Martins
authors.initials: AM
authors.lastname: Giron
authors.affiliation: Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil.
authors.forename: Marcos Figueiredo
authors.initials: MF
authors.lastname: Mello
authors.affiliation: Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil.
authors.forename: Cristovao Machado Barbosa
authors.initials: CMB
authors.lastname: Neto
authors.affiliation: Division of Urology, The Hospital for Sick Children, University of Toronto, Canada.
authors.forename: Joana Dos
authors.initials: JD
authors.lastname: Santos
authors.affiliation: Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil.
authors.forename: Paulo Renato Marcelo
authors.initials: PRM
authors.lastname: Moscardi
authors.affiliation: Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil.
authors.forename: Victor
authors.initials: V
authors.lastname: Srougi
authors.affiliation: Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil.
authors.forename: Francisco Tibor
authors.initials: FT
authors.lastname: Denes
authors.affiliation: Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery*; D013520:Urologic Surgical Procedures
keywords: Surgical Procedures, Operative ; Urethra; complications [Subheading]