Duplicate urethra
Introduction
Repeated urethra introduction Duplication of urethra means that in addition to the normal urethra, there is a paraurethral tract that is or is not connected to the bladder on the dorsal or ventral side, which is an extremely rare congenital urethra deformity. The two urethra can be connected to the bladder separately or below the bladder. The penis can be combined and the bladder repeated. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: urethral stricture
Cause
Repeated urethra etiology
(1) Causes of the disease
The real reason for repeating the urethra is not very clear. There are many kinds of doctrines, but each doctrine cannot explain the causes of all types. The main theories are:
1. Das (1977) believes that during the development of the embryonic urethra, the development of the penis and urethra plates are unbalanced and uncoordinated, and the following three situations occur:
(1) The penis of the genitourinary sinus has developed, and the urethral fistula is stunted. Because the penis has developed, the genitourinary sinus also develops along with the penis, forming the paraurethral tract. When the urethra is formed, the urethra begins to develop. The positive urethra is formed, and the result is the type I repeat urethra.
(2) The fusion of genital folds and malformations caused the urethra to cross, resulting in the formation of type II incomplete repeat urethra.
(3) The Philippine tube and the Müller tube play an important role in the differentiation of the male and female urethra. The Philippine tube is dominant, that is, it develops into the female urethra. In the urinary tract development process, if the Philippine tube is at a disadvantage at the beginning, the urethra is open. The perineum, and then the Philippine tube changed from a disadvantage to an advantage, the urethra developed into a male urethra with the penis, resulting in a repeating urethra, one urethra opening in the perineum, another urethra developing along the penis, opening in the penis The head, the type III repeat urethra.
2.Wilson believes that (1971), the urinary rectal fistula divides the acupuncture anal into two cavities, the front develops into the bladder and the posterior urethra, and the posterior anus rectum develops. The urogenital sputum stops at the auricular membrane. If it continues to develop downward, The urethra is also divided into two parts, the first urinary tract.
3. The interstitial is inserted from the side of the urethra primordium, separating the urethra into two lumens (Tripathi, 1969).
4. When the urethral groove intersects in the embryo, the repeat urethra is formed into type II (Moog, 1968).
(two) pathogenesis
1. Upper urethra-split repeat urethra This is the most common type of recurrent urethra deformity. The main urethra is located in the ventral side of the penis, and the paraurethra is located on the dorsal side of the penis. The main subtypes are:
(1) Complete type: Both urethra are connected to the bladder.
(2) Incomplete type: After the urethra exits the bladder, it is forked at the root of the penis to form the upper and lower urethra.
(3) hypoplasia type: the posterior segment of the paraurethra is extremely hypoplastic and atrophy.
2. Hypospadias repetitive urethra, the paraurethral urethra is located in the ventral side of the penis, one of the urethra forms a hypospadias opening, the main subtypes are:
(1) Complete type: the two urethra completely enter the bladder, and the distal end forms the hypospadias and the orthotopic urethra.
(2) Incomplete type: the urethra is bifurcated after the bladder, forming a urethral urethra and a urethral orifice.
(3) hypoplasia type: the blind end urethra is located in the dorsal position of the hypospadias.
3. The fusiform urethra divides into a repeating urethra in the middle, and begins to split after the bladder neck.
4. The anterior and posterior urethra of the anus is bifurcated after the bladder, and the distal end of the urethra communicates with the anal canal to form an anal anterior and posterior urethra deformity.
Prevention
Repeated urethra prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Repeated urethral complications Complications urethral stricture
Repeated urethra often complicated with other organ malformations, such as kidney, ureteral malformation, double bladder, double penis (double clitoris), uterine hypoplasia, no vagina, gonadal ectopic, spinal and intestinal malformations, etc., therefore should be comprehensively examined.
Symptom
Repeated urinary tract symptoms Common symptoms Urine bifurcation incontinence dysuria and urinary retention edema dysuria urinary tract hypospadias
Repeated urinary tract clinical manifestations are not consistent, related to its type, the most common symptoms are urinary tract infection, paraurethral urinary flow is not smooth, so the secondary urethra often has infection, because the lesion is concealed, often a lesion of chronic urinary tract infection.
The first type and the inner mouth communicate with the normal urethra, and the type II repeat urethra of the outer mouth. The urine is discharged from the two urethral orifices during urination, which is double-stranded, the urinary tract of the para-urethra is fine, and some drops only a few drops of urine. The paraurethral urethra can not only urinate, but also ejaculate, some only discharge fine without urinating, type III repeat urethra when urinating, perineal leakage or rectal urination, if the proximal end of the urethra is blind, not connected with the urethra Only the external urethra can be seen, neither urinating nor ejaculation. If the distal end of the urethra is blind, and the secretions accumulate after infection, the paraurethral dilatation is cystic, shaped like a urethral diverticulum, a paraurethral opening. At the back of the penis, the distal end of the urethral opening is cord-like, the same as the upper urethra, and the penis bends to the dorsal side when it is erect, affecting sexual life.
Type I repeat urethra of urethral smooth muscle hypoplasia, about half of patients have urinary incontinence, mild urinary incontinence, severe urinary incontinence, type II if the urethra is inflamed, mucosa at the urethral bifurcation Edema, or accumulation of secretions in the paraurethral tract, can compress the urinary tract and cause urinary dysfunction, resulting in symptoms of urethral obstruction.
Examine
Repeated urethra examination
Retrograde urethrography and urinary bladder urethrography can determine the relationship between the paraurethral and normal urethra, injecting methylene blue through the paraurethral orifice, and then urinating, can determine whether the paraurethral and the normal urethra and bladder communicate, when the urethoscopy, by the vice The urethra is injected with methylene blue, and it is easier to see the position of the paraurethral opening in the urethra. The urethral probe is used to infiltrate the paraurethral orifice and the normal urethral orifice at the same time, and the relationship between them can also be detected.
Diagnosis
Repeated urethra diagnosis
Repeated urethra, due to its different types, clinical manifestations, its diagnosis in addition to clinical symptoms, signs, according to urethral retrograde angiography and excretory bladder urethra to make a diagnosis, and can understand the relationship between the paraurethral and normal urethra and bladder .
Type III paraurethral tract should be differentiated from perineal urethral fistula and urethral rectal fistula. Acquired urinary fistula often has a history of trauma or infection, and more complicated urethral stricture. Vertebral dysfunction can be associated with congenital perineal urethral fistula and urethra rectal paralysis. The difference is that the pressure of the urethra and rectum is low, and the paraurethra has smooth muscle and the pressure is high.
