Caudal Duplication Syndrome: A Case Report Emphasizing Functional Assessment in Surgical Management

Caudal duplication syndrome (CDS) is an extremely rare congenital anomaly involving variable duplication of genitourinary, gastrointestinal, and neural structures. We report a male infant with complete duplication of the bladder, urethra, prostate, penis, scrotum, and colon, associated with a tethered spinal cord and a colovesical fistula. The fistula was not identified on initial imaging and was detected only during intraoperative cystoscopy and cystogram, underscoring the diagnostic limitations of early radiologic evaluation in CDS. Management was staged and prioritized according to functional urgency. Initial treatment focused on spinal cord detethering and resection of the accessory colon to address neurological risk and prevent recurrent infection. Urologic intervention was subsequently guided by videourodynamic findings, favoring a minimally invasive, function-preserving strategy rather than extensive anatomical resection. After functional stability was achieved, aesthetic genital reconstruction was performed to optimize external genital symmetry and reduce potential psychosocial impact. This case highlights the highly unpredictable anatomical variability of CDS and reinforces the need for individualized, multidisciplinary management tailored to functional priorities rather than anatomical duplication alone. Long-term follow-up is essential to monitor urinary continence, bladder compliance, and future reproductive potential throughout growth.