Images in Paediatrics
Double meatus. Anything beyond?
Doble meato ¿Esconde algo más?
Paula Salcedo Arroyo
, Yurema González Ruiz, Javier Pisón Chacón, Reyes Delgado Alvira
Corresponding author
Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, Spain
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e5" "paginaFinal" => "e6" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Paula Salcedo Arroyo, Yurema González Ruiz, Javier Pisón Chacón, Reyes Delgado Alvira" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Paula" "apellidos" => "Salcedo Arroyo" "email" => array:1 [ 0 => "paulasalcedo93@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Yurema" "apellidos" => "González Ruiz" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Pisón Chacón" ] 3 => array:2 [ "nombre" => "Reyes" "apellidos" => "Delgado Alvira" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Doble meato ¿Esconde algo más?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 867 "Ancho" => 900 "Tamanyo" => 39002 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0110" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Physical examination finding double meatus: a main (apical) meatus and an accessory (dorsal) meatus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a boy aged 5 years referred to the paediatric urology clinic for assessment of a double urethral meatus, which was asymptomatic: there was no passage or dribbling of urine through the dorsal meatus. Two meatuses were observed in the physical examination, one in the normal anatomical location and in a dorsal location (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The voiding cystourethrogram confirmed complete urethral duplication with a normal urethra and an accessory urethra originating from the main prostatic urethra at the level of the verumontanum (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), corresponding to type 2 coronal complete urethral duplication in the classification of Lima et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The patient underwent surgical intervention with circumcision, dissection and excision of the dorsal duplicated urethra, measuring 5<span class="elsevierStyleHsp" style=""></span>cm in length, with ligation of the base (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). An 8 Fr urinary catheter was also inserted. The patient had a favourable outcome in the immediate postoperative period, allowing removal of the urinary catheter, and was discharged 24<span class="elsevierStyleHsp" style=""></span>h after the intervention. In the follow-up visits, it was reported that he remained asymptomatic.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Urethral duplication is a rare congenital anomaly of unknown incidence. There are different classifications. The earliest ones were proposed by Williams and Kenawi<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in 1975 and by Effmann et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in 1976 and, more recently, in 2016, Lima et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> proposed an anatomical-functional classification. It is a clinical spectrum that ranges from the absence of symptoms to the development of infection, urinary incontinence and penile curvature.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A physical examination of the genitals and perineum is necessary to suspect the diagnosis, with visualization of a second meatus, noting its location and likely trajectory.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The anatomy of the duplicated urethra can be determined by means of imaging tests with contrast and cystourethrography, allowing differentiation of the main urethra and the accessory one and assessment of the integrity of the former for the purposes of planning the surgical management.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-09-18" "fechaAceptado" => "2021-10-06" "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 867 "Ancho" => 900 "Tamanyo" => 39002 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0110" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Physical examination finding double meatus: a main (apical) meatus and an accessory (dorsal) meatus.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 846 "Ancho" => 1500 "Tamanyo" => 96840 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0115" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Voiding cystourethrogram: type 2 complete coronal urethral duplication, according to the classification of Lima et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 626 "Ancho" => 1250 "Tamanyo" => 104754 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0120" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Surgical intervention: dissection and removal of duplicated urethra. (B) Postoperative outcome.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practical and functional classification of the double urethra: a variable, complex and fascinating malformation observed in 20 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Lima" 1 => "F. Destro" 2 => "M. Maffi" 3 => "D. Persichetti Proietti" 4 => "G. Ruggeri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Urol." "fecha" => "2017" "volumen" => "13" "numero" => "1" "paginaInicial" => "42.e1" "paginaFinal" => "42.e7" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urethral duplications in the male" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.I. Williams" 1 => "M.M. Kenawi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Eur Urol" "fecha" => "1975" "volumen" => "1" "numero" => "5" "paginaInicial" => "209" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1233186" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Duplication of the urethra" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.L. Effman" 1 => "R.L. Lebowitz" 2 => "A.H. Colodyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/119.1.179" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1976" "volumen" => "119" "paginaInicial" => "179" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/943804" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000010000000005/v1_202405192134/S234128792400070X/v1_202405192134/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000010000000005/v1_202405192134/S234128792400070X/v1_202405192134/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128792400070X?idApp=UINPBA00005H" ]
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