The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus

OBJECTIVE: To define the neonatal management and ultimate surgical correction via the anterior sagittal transanorectal approach (ASTRA) in cases of neonatal urinary hydrometrocolpos associated with a persistent urogenital sinus (UGS). PATIENTS AND METHODS: We report three patients with UGS (with no ambiguous genitalia) and urinary hydrometrocolpos in whom prenatal ultrasonography showed cystic dilatation of the pelvis. Two patients were temporarily treated with intermittent vaginal catheterization and antibiotic prophylaxis, and in one a cystostomy was necessary to temporarily drain the urine. At the age of 6-8 months the patients underwent reconstructive surgery of the UGS via the ASTRA, under a previous protective colostomy. RESULTS: The mean (range) age of the patients at the last follow-up was 18.7 (8-32) months. A good cosmetic result was obtained in all patients. The vagina was dilated briefly with no anaesthesia in each patient. Patients had normal faecal control after the colostomy was closed and none had urinary incontinence. CONCLUSIONS: When possible, intermittent vaginal catheterization permits sufficient temporary drainage of the urinary hydrometrocolpos associated with a persistent UGS. Subsequent ASTRA allows good exposure of the UGS, assuring the preservation of the anorectal innervation and of the sphincteric mechanism.