• **Management of bladder and urethral duplication**

Sagittal urethral duplication (side-by-side) is associated with bladder duplication and is specific for CDS. The two bladders can be completely separate or have a sagittal septum (most commonly two asymmetric sides) each with a ureter from the ipsilateral kidney and its own urethra. Urologic management in the first year of life is almost always conservative. Anatomic evaluation should be complemented with bladder function assessment especially in symptomatic patients. The goal is to avoid recurrent urinary infections, to ensure there is efficient emptying of both bladders and urinary continence. In most female patients, unilateral removal of the urethra is not necessary if asymptomatic. In males, the urethra will be excised when the decision for cosmetical penectomy is made [13], and it can be postponed until adolescence to let the patient decide, to assess penile growth and erectile function.

Assessment of continence potential is important in the development of any anorectal and urinary reconstruction plan. The type and severity of spinal cord and sacrum malformation have a direct role in predicting the fecal and urinary continence [14,15]. This can be assessed very early on and will influence the choice of surgical procedures as for example the decision to remove the bladder septum creating a bigger capacity bladder with bladder neck ligation and ipsilateral urethral removal or to keep the one or two appendices for antegrade continent enema (ACE)and/or appendicovesicostomy [16].
