A Case of Distal Vaginal Agenesis Presenting With Recurrent Urinary Tract Infection and Pyuria in a Prepubertal Girl

Abstract

BackgroundIsolated distal vaginal agenesis is a rare Müllerian duct anomaly and usually presents at or after menarche with a complaint of abdominal pain due to hematometrocolpos. We describe an unusual presentation of this anomaly in a prepubertal girl.CaseA 11-years-old girl with a history of recurrent urinary infection, pyuria and right-sided renal agenesis was referred to our tertiary care center. Gynecologic examination revealed normally developed labia majora and minora with absence of an external vaginal opening (Figure 1). She hadn’t had breast, pubic and axillary hair development. Transrectal ultrasound demonstrated upper vagina and uterus filled with fluid. Opening of dystal vaginal agenesis was planned. Pyocolpos was discharged following dissection of about three centimeters atretic portion. Uterus and vagina were found to be filled with pus. Pull-through vaginoplasty procedure was performed and vaginal mold was placed (Figure 2). After 1 week antibiotherapy and a result of sterile urine culture, cystoscopy was performed for suspicion of congenital vesicouterine fistula but no abnormalities were seen. Postoperative period was uneventful and mold left in place for three months. The authors theorize that pyuria could have resulted from transition of pus from pycolpos through the vagina and bladder wall.CommentsFigure 2Postoperative view of external genitalia of the patient.View Large Image Figure ViewerDownload Hi-res image Download (PPT) BackgroundIsolated distal vaginal agenesis is a rare Müllerian duct anomaly and usually presents at or after menarche with a complaint of abdominal pain due to hematometrocolpos. We describe an unusual presentation of this anomaly in a prepubertal girl. Isolated distal vaginal agenesis is a rare Müllerian duct anomaly and usually presents at or after menarche with a complaint of abdominal pain due to hematometrocolpos. We describe an unusual presentation of this anomaly in a prepubertal girl. CaseA 11-years-old girl with a history of recurrent urinary infection, pyuria and right-sided renal agenesis was referred to our tertiary care center. Gynecologic examination revealed normally developed labia majora and minora with absence of an external vaginal opening (Figure 1). She hadn’t had breast, pubic and axillary hair development. Transrectal ultrasound demonstrated upper vagina and uterus filled with fluid. Opening of dystal vaginal agenesis was planned. Pyocolpos was discharged following dissection of about three centimeters atretic portion. Uterus and vagina were found to be filled with pus. Pull-through vaginoplasty procedure was performed and vaginal mold was placed (Figure 2). After 1 week antibiotherapy and a result of sterile urine culture, cystoscopy was performed for suspicion of congenital vesicouterine fistula but no abnormalities were seen. Postoperative period was uneventful and mold left in place for three months. The authors theorize that pyuria could have resulted from transition of pus from pycolpos through the vagina and bladder wall. A 11-years-old girl with a history of recurrent urinary infection, pyuria and right-sided renal agenesis was referred to our tertiary care center. Gynecologic examination revealed normally developed labia majora and minora with absence of an external vaginal opening (Figure 1). She hadn’t had breast, pubic and axillary hair development. Transrectal ultrasound demonstrated upper vagina and uterus filled with fluid. Opening of dystal vaginal agenesis was planned. Pyocolpos was discharged following dissection of about three centimeters atretic portion. Uterus and vagina were found to be filled with pus. Pull-through vaginoplasty procedure was performed and vaginal mold was placed (Figure 2). After 1 week antibiotherapy and a result of sterile urine culture, cystoscopy was performed for suspicion of congenital vesicouterine fistula but no abnormalities were seen. Postoperative period was uneventful and mold left in place for three months. The authors theorize that pyuria could have resulted from transition of pus from pycolpos through the vagina and bladder wall. Comments