treatment involves excision of the accessory urethra usually through a suprapubic open approach . we report a novel use of extra peritoneal pelvic laparoscopic approach to disconnect accessory urethra from normal urethra in complete urethral duplication . a 10-year - old boy presented with stress incontinence , splaying of urinary stream , and dorsal curvature of the penis . he had an intact foreskin , which , when retracted , revealed a dorsally grooved glans with two meati : one at the tip and the other smaller one at the corona . the prepuce itself was reverse aligned with the frenulum being dorsal , as in epispadias . first surgery : cystoscopy , correction of chordee , repair of glans , rearrangement of foreskin and partial excision of the dorsal urethra . on cystoscopy , the ventral urethra , bladder neck and posterior urethra were normal . a tube passed through the dorsal urethra was seen entering the ventral urethra at the posterior urethra just opposite the veru . the dorsal accessory urethra was partially excised in the distal shaft and glans repaired to achieve a conical glans with normal coronal collar . the skin was re - arranged to give a circumcised appearance [ figure 1 ] . post - operatively he passed urine through both the meati but finger occlusion of the dorsal meatus produced one stream through the normal meatus . chordee has been corrected second surgery performed after 1 year : through a suprapubic 10 mm port the prevesical space was developed with finger dissection and co2 insufflation . two 5 mm ports were inserted as shown in figure 2a ( inset ) . in the space of retzius the accessory urethra was identified as it entered the normal urethra at the prostate . the accessory urethra was severed from the normal urethra using bipolar cautery and scissors [ figure 2a ] . the distal stump of the accessory urethra was obliterated by cautery ablation of the mucosa with monopolar electrode passed through the meatus [ figure 2b ] . inset shows port placement schematic diagram showing mucosal excision of the distal portion of the accessory urethra first surgery : cystoscopy , correction of chordee , repair of glans , rearrangement of foreskin and partial excision of the dorsal urethra . on cystoscopy , the ventral urethra , bladder neck and posterior urethra were normal . a tube passed through the dorsal urethra was seen entering the ventral urethra at the posterior urethra just opposite the veru . the dorsal accessory urethra was partially excised in the distal shaft and glans repaired to achieve a conical glans with normal coronal collar . the skin was re - arranged to give a circumcised appearance [ figure 1 ] . post - operatively he passed urine through both the meati but finger occlusion of the dorsal meatus produced one stream through the normal meatus . chordee has been corrected second surgery performed after 1 year : through a suprapubic 10 mm port the prevesical space was developed with finger dissection and co2 insufflation . two 5 mm ports were inserted as shown in figure 2a ( inset ) . in the space of retzius the accessory urethra was identified as it entered the normal urethra at the prostate . the accessory urethra was severed from the normal urethra using bipolar cautery and scissors [ figure 2a ] . the distal stump of the accessory urethra was obliterated by cautery ablation of the mucosa with monopolar electrode passed through the meatus [ figure 2b ] . inset shows port placement schematic diagram showing mucosal excision of the distal portion of the accessory urethra urethral duplications usually occur as an isolated deformity in males , the two urethra lying one behind the other in a sagittal plane . usually the normally placed ventral urethra is more functional and contains the sphincter mechanism and verumontanum . our case had an incomplete epispadic sagittal duplication as per william 's classification . however , as per effmann classification it falls into complete patent duplication type ii ( a2 ) . surgery to excise the accessory urethra has traditionally involved a combined suprapubic and penile approach to deal with the proximal end and the distal end , respectively . the key step is suprapubic disconnection of the accessory urethra from the good ventral urethra through dissection in the retropubic space . this is technically difficult due to limited space , and risk of venous bleeding from a rich prostatic venous plexus , and carries a risk of damage to the normal urethra , sphincter mechanism and the nerves . however , it would have been a major undertaking considering the length of the tract and its course between the corpora cavernosa . it would have been technically difficult to reach under the pubic bone to completely excise the distal portion . the laparoscopic pre - peritoneal approach has been used in adults for excision of benign prostatic enlargement and in partial cystectomy for bladder pheochromocytoma . the reported advantages are minimal bleeding , a reduced transfusion rate , shorter hospitalization , reduced morbidity and faster recovery . . however , the pre - peritoneal laparoscopic approach for disconnection of accessory urethra has not been described in children to the best of our knowledge . insufflations of gas then result in pressure dissection which creates more space to insert working ports . the visualization of accessory and the main urethra is easy as the view is magnified , free from bleeding and well  retracted  . since this is probably the first case report of such a procedure in urethral duplication , there is no available data in the literature about dealing with the stump . however , there is now sizable experience with laparoscopic pull thru for anorectal malformations with several authors leaving the stump of rectourethral fistula open with no ill effects . transfixation , suture closure and closure by an endo - loop are other options . identification of the good urethra was a key safety step . in case of difficulty