PMC5905857_01
Voiding cystourethrogram, observing hypoplastic urethra running parallel to the main urethra (2nd urethra), and perineal urethra in Y (3rd urethra).
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A new cystography was performed, confirming the previously known two urethras and, in addition, a third urethra was seen from posterior urethra to perineum in "Y" shape (Fig. 1).
(A-D) The patient was found to have an epispadic urethra (2nd urethra) and perineal urethra (3rd urethra). (E-H) Surgical treatment was performed on the perineal urethra.
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(A) Flexible cystoscopy (retrograde vision when rotating 180 grades the flexible ureteroscope) shows the entry of epispadic urethra into the bladder immediately superior to the bladder neck (2nd urethra). The main urethra and perineal urethra (3rd urethra) enter the bladder through the bladder neck. (B) Rigid cystoscopy shows a perineal urethra (3rd urethra) starting in the posterior urethra. Entrance of the perineal urethra in the primary urethra was coagulated under cystoscopic control.
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Subsequently, flexible cystoscopy with flexible microureteroscopy was performed, which showed that the epispadic urethra ran parallel to the primary urethra and enters the bladder immediately superior to the bladder neck (Fig. 3).