Urethral duplication in a female child

Abstract

Introduction: Urethral duplication in girls is a very rare congenital pathology. Successful surgical reconstructive treatment heavily depends on appropriate clinical examination and evaluation of anatomy. Material and methods: We describe a case of successful treatment of type II urethral duplication according to Stephens in a 2.5-year-old girl. Results: Several fever episodes in infancy, recurrent urinary tract infections (UTI) since the age of 1 year. Daytime incontinence from 2 years, following complete disability to control urination. A spherical formation in the region of the labia, collapsing after outflow of urine. Referred to the The Hospital of Lithuanian University of Health Sciences Kauno klinikos at 2.5 years Examination: height - 25‰, weight - 3‰, deep eye sockets, wide nasal bridge, broad shoulders, large abdominal girth, hypertrophic clitoris. XX karyotype, normal kidney function. UTI (Enteroccocus faecalis) was diagnosed. Kidney ultrasonography: bilateral ureterohydronehrosis, megacystis. Post void residual - 115 mL. MAG-3: bilateral obstructive curves with slow excretion after furosemide infusion (accumulation of radioisotope media in diluted ureters). Right kidney function - 71% of total kidney function, left kidney - 29%. Cystograms - left kidney V° VUR. Gynecologist, endocrinologist: clitoral hypertrophy. Cystoscopy: large trabeculated urinary bladder, ureter foramina not open, two urethrae - one opening into the clitoris, the other opening normally into the perineum. Surgery was performed: 0.5-cm fragment of urethra removed in the area of the clitoris, clitoroplasty, Foley catheter inserted. Microscopy analysis of the segment: visible cavernous bodies making up the clitoris, urethra lined with urethral epithelium. The Foley catheter was removed after 4 days, urinary bladder catheterization every 3 h due to valvelike bladder. The patient was no longer incontinent, ultrasonography reveal[...].