• **Management of genital duplication**

Gender distribution shows a predilection of CDS in females with a complete but well-developed duplicated external and internal genital organ and preserved ovarian function. Almost always, corrective genital surgery in females is not necessary unless one side is hypoplastic and might cause menstrual flow obstruction or for cosmetic concerns, in which case, it can be removed [10]. If congenital uterine anomalies such as septate or subseptate uteri have a risk for reduced conception rate, increased risk of first trimester miscarriage (especially with septal implantation), preterm birth, and fetal malpresentation, patients with didelphys uterus do not appear to have reduced fertility and have less pregnancy complications, but might be at increased risk for preterm labor [17]. All our adult female patients carried pregnancies to term and in three out the four cases [3,18–20] presented for pregnancy related issues (genetic counseling, symptomatic ureteral compression or vaginal prolapse, and voiding dysfunction after multiple pregnancies). Cesarean section was performed in all cases. In cases with a history of multiple abdominal surgeries and depending on the complexity of procedures, the cesarean surgery should be assisted by a colorectal surgeon and/or urologist. Male patients present with complete or partial penile duplication and are more likely to be corrected for cosmetic reasons with removal of one of the abnormal shafts [13] or penoplasty [12]. There are no reports assessing fertility and sexual function into adult age in CDS male patients.
