Urethral duplication presenting as a prepubic sinus in a male: A case report

Background: Congenital prepubic sinus (CPS) is a rare congenital variant of urethral duplication, with less than 50 cases documented in the scientific literature since it was first reported by Campbell et al., in 1987. Case presentation: An 8-year-old male patient complained of an inflammatory secretion from a sinus opening on the dorsal base of his penis. Physical examination revealed an accessory orifice in the midline of the dorsal proximal penis without any penile curvature. An ultrasound (US) examination found an 8-mm collection of cutaneous and subcutaneous tissue at the dorsal base of the penis. The renal US, however, showed no abnormalities. Additionally, micturating cystourethrogram (MCUG), was negative for vesicoureteral reflux (VUR). Retrograde sinusography (RS) and urethrogram showed no communication between the urinary tract, and the sinus was found to end blindly at the level of the pubic symphysis. A surgical excision was decided, to avoid potential future complications. A 3-cm-long intact sinus was dissected and excised entirely. Histological examination confirmed the diagnosis of a urethral duplication. The postoperative course was uneventful. To date, at six-month of follow-up, the patient remains asymptomatic. Conclusions: The histological findings in this case support the theory that CPS is a variant of dorsal urethra. Urethral duplication should always be suspected in the case of accessory dorsal openings. Surgical excision is recommended at an early age, even in the absence of symptoms, to improve aesthetics, prevent recurrent infections and avoid the development of future malignant tumors. © 2023