PMC8033237_01
(a) Black arrow - anterior/accessory urethra, red arrow - posterior/ orthotopic urethra, green arrow - vaginal opening. (b) Metal dilators in both the urethras. (c) Black arrow showing internal opening of the anterior/ accessory urethra, blue arrow showing internal opening of the posterior/orthotopic urethra
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F1
Physical examination revealed two urethral openings, one below the other in the sagittal plane, below the clitoris [Figure 1a, 1b and 3b] (Diagramatic representation)]. The posterior urethra was in the orthotopic position and was opening into the large capacity bladder [red arrow in Figure 1a]. The anterior urethra was present just posterior to the clitoris [anterior/accessory urethra - black arrow in Figure 1a]. The internal opening of the accessory (anterior) urethra was located about 2 cm cranial to the bladder neck on the anterior wall of the urinary bladder (Figure 1c). Green arrow in Figure 1a shows the vaginal opening.
(a) Intravenous pyelogram showing s large capacity bladder with left gross hydroureteronephrosis and severely tortuous left ureter suggestive of left obstructive megaureter. (b) Micturating cystourethrogram showing very large capacity of the bladder
IJU-37-79-g002.jpg
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F2
Intravenous pyelogram (IVP) showed a large capacity bladder with left gross hydroureteronephrosis and severely tortuous left ureter [Figure 2a] suggestive of left obstructive megaureter. Micturating cystourethrogram also revealed a very large capacity bladder [Figure 2b].
(a) 1 - Box showing accessory urethral tract that was excised. 2 - Orthotopic/posterior normal urethra with sphincter system. 3 - Vaginal opening. (b) 1- Clitoris. 2 - Posterior/orthotopic urethra. 3 - Anterior/accessory urethra. 4 - Vaginal opening
IJU-37-79-g003.jpg
PMC8033237_01_IJU-37-79-g003.jpg
F3
Physical examination revealed two urethral openings, one below the other in the sagittal plane, below the clitoris [Figure 1a, 1b and 3b] (Diagramatic representation)]. Line diagram showing the position of urethra and vagina are given in Figure 3. The excision of the accessory urethra (Figure 3a) was performed with the child in the lithotomy position through the abdominoperineal route.