A Thorough Genital Examination is the Key

Abstract

A 9-year-old girl was referred for daytime wetting and nocturnal enuresis. She voids 6 times per day with good quantities but continuous dribbling was noted. There was no urgency, frequency or previous surgeries. Four years ago, urodynamic studies in another institution showed no detrusor overactivity at the filling phase, a capacity of 160 ml, low detrusor pressure and no post-void residue. CT urogram revealed normal kidneys and ureters with Urine filling the vagina (Figure 1). Her pediatric urologist taught her the correct voiding posture with opening thighs without improvement. Current examination of the external genitalia revealed a normal appearing vulva, one orifice leaking urine and an imperforate hymen (Figure 2A). Under general anesthesia, hymenectomy was performed and a hypospadic urethra was noted (Figure2B-2C). Cystovaginoscopy was within normal limits. Postoperatively, patient became continent. One year later, she is still doing well.