case_images: PMC11778702_01
case_images: Retrograde urethrogram through external urethral meatus and cystogram done by filling bladder through anal opening. A marker was put at the anal verge
case_images: IJU-41-69-g001.jpg
case_images: PMC11778702_01_IJU-41-69-g001.jpg
case_images: iju_264_24-f001
case_images: Injecting contrast through anal opening showed a fistulous communication between the bladder and anal canal [Figure 1].
case_images: (a) Superolateral opening leading to blind tract ending at the bladder neck, a posterior double urethra. Superomedial opening leading to anterior urethra containing the guide wire (b) Inferolateral opening leading to posterior urethra connecting to the bladder with short posterior urethra of 1 cm from bladder neck to veru. Pyridium efflux can be seen from ectopic right ureteric opening just beyond the bladder neck (black arrow) (c) Inferomedial opening leading to left ectopic ureter up to 25 cm (d) Right ejaculatory duct filled with multiple stones for which lithotripsy was done with Holmium: YAG laser in same sitting (red arrow) (e) Pictorial description of the urethral anomaly
case_images: IJU-41-69-g002.jpg
case_images: PMC11778702_01_IJU-41-69-g002.jpg
case_images: iju_264_24-f002
case_images: Inferomedial opening-Left ectopic ureter (reaching 25 cm up to left kidney) [Figure 2].
case_images: (a) Incision marking for the surgery. There were openings on the anterior aspect of the anal verge with the posterior aspect leading to the rectum. A guidewire (blue arrow) passed through the external meatus is seen coming out at the anal verge. Yellow colored access catheter is seen coming out from the left ectopic ureteric orifice (black arrow). A silicon catheter was placed through the normal posterior urethra into the bladder. The rectum was packed with iodine-soaked gauze to avoid soiling during surgery (b) Atretic bulb of the urethra with no urethral lumen (yellow arrow) (c) Circumferential Q-shaped penile fasciocutaneous flap raised on dartos (d) Flap tabularized over 14 Fr silicon catheter (e) Proximal anastomosis of the flap (blue arrow) (f) Urethrostomy made at proximal-penile shaft level (g) Reconstruction diagram (h) Completed repair with urethrostomy at proximal-penile level
case_images: IJU-41-69-g003.jpg
case_images: PMC11778702_01_IJU-41-69-g003.jpg
case_images: iju_264_24-f003
case_images: A 15-cm circumferential Q-shaped penile fasciocutaneous flap was used for reconstruction, which reached the penoscrotum as a urethrostomy [Figure 3].