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Novel approach to vaginal calculus in a girl with urogenital sinus anomaly
Ravibindu Sujeewa Ranawaka1, Anju Goyal1, Abdusamea Shabani2
1Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom.
Insights
Isolated urogenital sinus anomalies can lead to serious health issues. This case highlights successful management of a hemivaginal stone and stenosis in a young girl, improving her urinary tract health.
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.
Abstract:
Isolated urogenital sinus can cause distended bladder and/or vagina and may present with an abdominal mass and sepsis during infancy. Older children may present with recurrent urinary tract infections and hematocolpos. We describe a 3-year-old girl with recurrent urinary tract infections thought to be secondary to vesicoureteric reflux. On further investigation, an isolated urogenital sinus anomaly with a calculus inside one of the hemivaginae was noted. She was managed expectantly with a plan to intervene at puberty. At puberty, during removal of the stone, the hemivaginal introitus was found to be stenotic. Gradually increasing sizes of Amplatz type graduated renal dilators were introduced from the introitus of the urogenital sinus into the hemivaginal stone until a size 22F Amplatz sheath could be passed easily. Size 10F cystoscope was passed through this channel, and the stone was fragmented using electrohydraulic lithotripsy. At a later date, she underwent staged anterior sagittal transvulval mobilization of the urogenital sinus.