Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

This boy was born with multiple anomolies and a vesicostomy was performed. He then was referred to Children's Hospital with the diagnosis of "three urethras". Evaluation through the vesicostomy showed duplication of the urethra with both channels in the penis and both meati near normal position. As is usually the case, the upper (dorsal) urethra was hypoplastic and the lower or underneath urethra (ventral) was the normal channel. In addition, there was a congenital urethral-perineal fistula (figure 1). He underwent excision of the fistula (figure 2). Then, at another operation, he had removal of the distal septum between the two urethras in the penis, creating one meatus (figure3). A follow-up retrograde urethrogram showed the singal distal channel, the hypoplastic dorsal urethra and the normal ventral urethra (figure 4).

References

1) Effman et. al., Duplication of the Urethra, Radiology, 1976, Vol. 119, No. 1, pp.179-185.

2)Bates and Lebowitz, Congenital Urethroperineal Fistula, Radiology, 1995, Vol. 194, No. 2, pp.501-504.