ESPN 50th Annual Meeting

ESPN 2017


 
Urethral duplication in a female child
DIANA DOBILIENE 1 JURATE MASALSKIENE 1 SARUNAS RUDAITIS 1 ENRIKA RAMOSKAITE 1 ARTURAS KILDA 2

1- THE LITHUANIAN UNIVERSITY OF HEALTH SCIENCES, DEPARTMENT OF PEDIATRICS
2- THE LITHUANIAN UNIVERSITY OF HEALTH SCIENCES, DEPARTMENT OF PEDIATRICS SURGERY
 
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 yrs.

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 Vº 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 hours due to valvelike bladder.  The patient was no longer incontinent, ultrasonography revealed subsiding urostasis.

Conclusions:

 Urethral duplication is a rare pathology in girls, requiring thorough physical examination and testing.