Novel approach to vaginal calculus in a girl with urogenital sinus anomaly

Area of Science:

• Pediatric Surgery
• Urology
• Gynecology

Background:

• Isolated urogenital sinus (IUGS) is a rare congenital anomaly.
• It can manifest in infancy with sepsis or in older children with recurrent urinary tract infections (UTIs) and hematocolpos.
• Early diagnosis and management are crucial for preventing complications.

Observation:

• A 3-year-old girl presented with recurrent UTIs, initially suspected to be due to vesicoureteric reflux.
• Further investigation revealed an IUGS anomaly with a calculus within a hemivagina.
• The patient was managed expectantly until puberty.

Findings:

• At puberty, the hemivaginal introitus was found to be stenotic during stone removal.
• Graduated renal dilators were used to achieve a 22F Amplatz sheath passage.
• A 10F cystoscope facilitated stone fragmentation via electrohydraulic lithotripsy.
• The patient subsequently underwent staged anterior sagittal transvulval mobilization of the urogenital sinus.

Implications:

• This case demonstrates a successful multi-stage surgical approach for managing complex IUGS with hemivaginal stone and stenosis.
• Effective treatment can resolve recurrent UTIs and prevent long-term complications.
• Highlighting the importance of thorough investigation for IUGS in children with recurrent UTIs.