Background: H-type urethral duplication is the most complex form of this uncommon anomaly.
Methods: This report describes the treatment of four such patients, three of which had hypoplasia of the entire anterior urethra, and one had anterior fusiform megalourethra.
Results: Satisfactory results were obtained in all four by staged surgical management in which the anal opening was transposed to the perineum, preserving the continence mechanism. Subsequently, urethroplasty was performed. In one patient, the megalourethra was tailored and incorporated into the urethroplasty in a third-stage procedure. All patients were well on follow-up.
Conclusion: With early treatment, good results can be achieved in this condition.