Urinary retention in an adolescent with a history of urethral transection

Urinary retention is rare in adolescence. Here I describe such a case in a patient who had transected her urethra in a motor vehicle accident at 3 years of age. The presumptive diagnosis of urethral stricture was proven incorrect.

Both to present a complicated and unique case whose history pointed strongly to one diagnosis initially but turned out very differently than expected; and to give an example of the use of bedside ultrasonography in the Emergency Department as a diagnostic tool in an unusual circumstance.

A 13-year-old girl was evaluated for 3 days of urinary retention. Her history of pelvic fracture and urethral transection in childhood suggested a urethral stricture. Her work-up revealed, however, a vaginal stricture and resultant hematocolpos compressing the urethra. Upon surgical excision, the stricture was confirmed to be scar tissue, rather than a coincidental congenital septum.

Hematocolpos is an uncommon but well-described cause of urinary retention in premenarchal females. This is a difficult diagnosis in any circumstance, and this patient's complex history complicated the process. It was the bizarre bedside ultrasound that prompted further work-up than simple urethral catheterization and urologic follow-up, which her urologist had suggested over the phone. This patient's case is unique in the literature.