Female urethral duplication with Hutch diverticulum and vesicoureteral reflux: a rare association

Urethral duplication is an uncommon congenital anomaly, exceptionally rare in girls, with very few cases reported worldwide. We present the case of a preschool-aged girl with recurrent urinary tract infections, ultimately diagnosed with right-sided grade V vesicoureteral reflux and a paraureteric (Hutch) diverticulum. Examination under anaesthesia revealed an additional urethral opening caudal to the orthotopic urethral meatus. Cannulation and cystoscopy confirmed urethral duplication, an association not previously reported in the literature. The patient underwent ureteric reimplantation and excision of the diverticulum, while the duplicated urethra was managed conservatively as it was asymptomatic. At the 6-month follow-up, she remained symptom-free with no further urinary tract infections. To our knowledge, this is the first report describing the association of female urethral duplication with high-grade vesicoureteral reflux and Hutch diverticulum and highlights the importance of considering urethral duplication in female patients with complex urinary symptoms and demonstrates a novel combination of urogenital anomalies.