Bladder outlet obstruction (BOO) is diagnosed through clinical urodynamics, an invasive method with many limitations, including side effects or surgical complications. This study introduces evaluation strategies for BOO recognition based on uroflowmetry test. In this study, a catheter-free male lower urinary tract (LUT) model was developed for hydrodynamics simulation. The pressure and velocity distributions in urethras with different obstruction degrees were analyzed under a fixed vesical pressure, and the effect of obstruction on urine flow under transient vesical pressure input was investigated. Dynamic analysis revealed that the assignments of urethral pressure and velocity were substantially influenced by the extent and location of obstruction. The global maximum pressure and velocity differences between obstructed and healthy urethra models reached 28.8 cm H2O and 2.41 m/s, respectively, at a constant bladder pressure input of 50 cm H2O. Vortices emerged at different segments along the obstruction, resulting in energy loss in the urine stream. Based on uroflowmetry data from 300 subjects, four dimensionless evaluation parameters were designed to distinguish healthy individuals from those with BOO, with p-values of < 0.001, 0.05, 0.001, and 0.02, respectively. The distributions of pressure, velocity, and vortex provide significant guidance for customized BOO surgery. In addition, the means and indicators of dimensionless evaluation have a crucial contribution to identify male BOO by uroflowmetry examination. Trial Registration: This experiment was certified by the Chinese Clinical Trial Registry (ChiCTR2200063467).

The temporary implantable nitinol device (iTIND) has emerged as a minimally invasive surgical technique aimed at improving symptoms while preserving erectile and ejaculatory function. Although functional outcomes and safety have been extensively studied, no previous research has specifically evaluated patient satisfaction and treatment regret. To assess functional outcomes, treatment satisfaction, and decision regret in patients undergoing iTIND implantation in a real-life multicenter setting. We retrospectively analyzed prospectively collected data from 140 patients treated with iTIND at 7 institutions between January 2022 and December 2023. Baseline evaluations included International Prostatic Symptom Score (IPSS), International Prostatic Symptom Score-quality of life (IPSS-QoL), urinary peak flow (Qmax), post voiding residual (PVR), and International Index of Erectile Function score (IIEF5). Antegrade ejaculation was recorded before and after treatment. Adverse events and retreatments were monitored. At 12 months, decision regret was assessed using the validated Decision Regret Scale (DRS). Logistic regression a less absolute shrinkage and selection operator models were applied to identify predictors of high regret (DRS >25). Median age was 52 years and median prostate volume was 30 mL. All procedures were successfully completed with same-day discharge. Functional outcomes significantly improved: IPSS decreased from 20 to 10 (p < 0.001), QoL from 4 to 2 (p < 0.001), Qmax increased from 8.5 to 13 mL/s (p < 0.001), and PVR from 52.5 to 20 mL (p = 0.013). Erectile function remained stable (IIEF5: 24 vs 26, p = 0.38), and antegrade ejaculation was preserved in most patients (78% vs 81%). At 12 months, 32% of patients (45/140) experienced high regret, while 68% (95/140) reported low regret. In multivariate analysis, early complications and retreatments were strong predictors of regret, whereas lower baseline Qmax was protective. iTIND provides significant clinical improvement with preservation of sexual function in men with LUTS/BPO. However, approximately one-third of patients reported high regret at 12 months, mainly linked to complications and retreatments. These findings stress the importance of integrating patient-reported outcomes, including regret, into the evaluation of minimally invasive therapies.

Functional imaging of the kidney in pediatric patients is typically performed using contrast-enhanced MR urography (MRU) or nuclear scintigraphy, both of which require either gadolinium-based contrast agents or ionizing radiation. Furosemide, a loop diuretic routinely used in both modalities to stimulate urinary flow, acutely increases tubular fluid volume. These changes in renal water content can be detected by MRI-based quantitative T2 mapping, which may provide a contrast- and radiation-free alternative for evaluating kidney function. To assess renal T2 relaxation time changes following intravenous furosemide administration as a surrogate marker for differential renal function (DRF) in pediatric MRU. In this prospective single-center study (June 2024 to March 2025), pediatric patients undergoing clinically indicated MRU received additional dynamic T2 mapping during furosemide administration using a respiratory-triggered gradient-and-spin-echo (GraSE) sequence. Two readers independently assessed T2 relaxation time changes. DRF was derived from the slope of the T2 increase (SlopeDRF) as well as from pre-T2 to post-T2 differences, expressed as each kidney's relative contribution to total function. These measures were compared with contrast-enhanced, Patlak-derived DRF (pDRF) using Pearson correlation and Bland-Altman analysis. Interreader agreement was assessed with the intraclass correlation coefficient (ICC). Thirty-two patients (16 males; median age: 7y, IQR: 0 to 11) were included. Renal parenchymal T2 relaxation times increased significantly after furosemide administration (pre: 118.4ms, IQR: 110.8 to 124.4; post: 134.8ms, IQR: 126.9 to 141.3; P < 0.001). SlopeDRF correlated strongly with pDRF (r = 0.81), and T2-difference DRF also demonstrated strong correlation with pDRF (r = 0.80). Interreader agreement for DRF was excellent (ICC = 0.94). Dynamic renal T2 mapping after intravenous furosemide administration shows strong correlation with Patlak-derived DRF from contrast-enhanced MRU and may provide a noninvasive, contrast- and radiation-free method for quantifying differential renal function in children.

Aquablation therapy is an effective treatment for benign prostatic obstruction. However, its functional outcomes in older patients remain underexplored. In this study, we aimed to compare improvements in lower urinary tract symptoms (LUTS) after Aquablation therapy in patients aged ≥ 75 and ≤ 74 years. We retrospectively analyzed data from 103 men with moderate-to-severe LUTS who underwent Aquablation between 2023 and 2025. Patients were stratified into two age groups (years): ≤ 74 (n = 72) and ≥ 75 (n = 31). Primary outcomes included changes in the International Prostate Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximum urinary flow rate (Qmax), and post-void residual (PVR) from baseline to 3 months postoperatively. Secondary outcomes included transfusion and complication rates. After 3 months, both groups showed significant improvements in total IPSS (-10.46 and -7.38 in those aged ≤ 74 and ≥ 75 years, respectively), QoL (-2.32 vs. -2.33), Qmax (+8.67 vs. +6.03 mL/s), and PVR (-89.1 vs. -75.3 mL; all p < 0.05). In the ≥ 75 group, voiding subscores, including incomplete emptying, intermittency, weak stream, and straining, improved significantly (p < 0.05), whereas storage symptoms, including frequency, urgency, and nocturia, did not (p = 0.07, 0.6, and 0.7, respectively). In patients aged ≤ 74 years, both voiding and storage symptom subscores improved significantly. No significant differences in operative time, transfusion rate, or complication rate were observed between groups. Aquablation therapy is a safe and effective surgical option for patients aged ≥ 75 years. In this older population, although storage symptoms were less treatment-responsive, substantial improvements in voiding symptoms and overall QoL were achieved.

The rodent Cerradomys goytaca is endemic to the coastal sandplains (restingas) of Brazil. This study aimed to investigate the renal morphology and physiology of this species to elucidate the possible mechanisms involved in urinary concentrating capacity and renal solute handling. Ten female specimens of C. goytaca werecompared with twenty female Wistar Rattus norvegicus. Feed intake and urinary flow were determined. The following parameters indicative of renal function were evaluated: clearance, fractional excretion, and urinary excretion of creatinine, osmolality, urea, sodium, potassium, and glucose. Additionally, morphological analyses of the kidneys were performed to evaluate cortical and medullary structure. C. goytaca showed a significantly higher renal mass index despite a lower nephron count compared to R. norvegicus. The species demonstrated the ability to produce more concentrated urine, with lower urinary flow and greater water reabsorption. Higher urinary excretion of sodium, potassium, and glucose was also observed. Together, these results suggest adaptive mechanisms for electrolyte and glucose handling, as well as water conservation, that may support the survival of this species in its natural habitat.

The Optilume® drug-coated balloon (DCB), combining mechanical dilation with localized paclitaxel delivery, is a novel minimally invasive treatment for urethral stricture disease. However, data on its effectiveness across different stricture locations are limited. This study evaluates functional outcomes following treatment for different strictures locations. This retrospective multicenter study included patients treated with Optilume® DCB for urethral strictures at five European tertiary care referral centers (June 2023 - June 2025). Stricture length was assessed by retrograde urethrography, cystoscopy, or both. Recurrence was defined as any symptomatic stricture requiring treatment. A multivariable logistic regression using preoperative data was developed to predict recurrence requiring treatment. In total 86 patients were included across four stricture locations: penile (n = 11, 13%), bulbar/penobulbar (n = 59, 68%), bulbomembranous/membranous (n = 13, 15%) and bladder neck (n = 3, 4%). Postoperative complications within 30 days occurred in 5 (5.8%) patients. Median follow-up duration ranged from 3 to 11 months. Median peak urinary flow increased from 3.5 to 8.8 mL/s preoperatively to 13.5-19 mL/s at 3 months. Stricture-free rates were highest in penile (91%) and bladder neck (100%) strictures, and lower for bulbar (74%) and bulbomembranous/membranous (69%) strictures. On multivariate logistic regression analysis, diabetes was an independent predictor of stricture recurrence (OR = 7.66, 95% CI 1.55-47.12, p = 0.01). Optilume® DCB showed encouraging efficacy and safety across different urethral stricture locations, achieving high stricture-free rates and improved urinary flow. Diabetes independently predicted recurrence, highlighting the value of optimizing modifiable risk factors.

A comparison of the modified Duckett versus conventional Duckett procedure for severe hypospadias: a retrospective single-centre cohort study.

Holmium laser enucleation of the prostate (HoLEP) has emerged as an alternative for benign prostatic obstruction (BPO), with fewer perioperative and functional complications. However, its comparative performance relative to robot-assisted simple prostatectomy (RASP) remains debated, requiring updated evaluation. A systematic review and meta-analysis of studies comparing HoLEP and RASP was performed using PubMed, Scopus, and Cochrane databases through August 2025. Outcomes were pooled using mean differences (MDs) and odds ratios (ORs) with random-effects models. Risk of bias assessment and trial sequential analysis were conducted to evaluate the robustness of evidence. Thirteen studies, including 1993 patients, were analyzed. HoLEP was associated with shorter operative time (MD = -32.05 minutes), lower transfusion rates (OR = 0.34), fewer Clavien-Dindo grades III and IV complications (OR = 0.39), and earlier catheter removal (MD = -3.84 days). Postoperative International Prostate Symptom Score modestly favored RASP (MD = 0.96). No significant differences were observed in quality of life, maximum urinary flow rate, International Index of Erectile Function, prostate-specific antigen reduction, postvoid residual volume, estimated blood loss, specimen weight, hospital stay, minor complications, trifecta achievement, or postoperative urge and stress incontinence. HoLEP provides improved perioperative safety with largely comparable functional outcomes compared with RASP. Further high-quality comparative studies are needed to confirm long-term effectiveness.

Sexual and Urinary Outcomes After iTind for Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis.

Finite element analysis-based evaluation of different pessaries for female cystocele intervention.

Purpose: Experimental hypohydration increases acute kidney injury (AKI) biomarkers, indicating potential kidney stress. Black adults are more likely than White adults to be underhydrated, yet it is unclear whether habitual hydration is associated with AKI biomarkers or whether racial differences exist, particularly in emerging adults. Methods: Fifty-four participants (24 Black/30 White, 27 M/27 F, age 21 ± 1 y, mean ± SD) provided diet diaries to assess water intake and collected 24-hour urine samples. We assessed hydration biomarkers (urine osmolality, urine specific gravity (USG)), creatinine clearance, and urinary AKI biomarkers, including kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), thioredoxin-1 (TRX-1), tissue inhibitor of metalloproteinases 2 (TIMP-2), insulin-like growth factor binding protein 7 (IGFBP7), and TIMP-2*IGFBP7. Results: Black adults exhibited higher USG (p=0.043) and urine osmolality (534(506) vs. 303(541) mOsm/kg, p=0.007, median (IQR)), and reported lower water intake (p<0.001), but there was no difference in creatinine clearance (p=0.250) compared with White adults. Black adults exhibited higher urinary NGAL, TIMP-2, IGFBP7, and TIMP-2*IGFBP7 (ps≤0.034) concentrations, but not urinary KIM-1 or TRX-1 (ps≥0.096) concentrations. When indexed to urine flow rate, the racial difference persisted only for TIMP-2*IGFBP7 (319(467) vs. 215(214) [ng/mL]2/min, p=0.014). In a regression model with sex, urine osmolality, and water intake (R2=0.596, p<0.001), race was no longer associated with TIMP-2*IGFBP7 (p=0.168). Mediation analysis revealed that water intake mediated 82.6% (p=0.007) of the race difference in TIMP-2*IGFBP7 (overall p=0.021). Conclusion: Racial disparities in urinary TIMP-2*IGFBP7 excretion between emerging Black and White adults may be mediated by water intake differences.

The diagnosis of urinary tract infection (UTI) remains a clinical challenge, with urine culture as the gold standard. In developing countries like Bosnia and Herzegovina, a high prevalence of antimicrobial resistance and frequent empirical treatment pose significant clinical challenges. Automated urine flow cytometry has emerged as a rapid tool to optimize diagnostic processes. To determine the correlation of age, gender, and laboratory parameters-such as white blood cell (WBC) count, neutrophil count, and C-reactive protein (CRP)-with both urinary bacterial counts and urine culture results. This retrospective study analyzed 200 adult patients (≥18 years) with symptoms suggestive of UTI at the University Clinical Center Tuzla. Data on age, gender, WBC, neutrophils, CRP, and urine flow cytometry (Sysmex UF-4000) were collected. Statistical analysis was performed using R software (version 4.5.1), utilizing logistic regression models via the 'glm' function to identify independent predictors, with statistical significance set at p < 0.05. The mean age of the population was 68.61 ± 15.19 years. Logistic regression demonstrated that WBC count (OR = 1.06, p = 0.004), neutrophil count (OR = 1.04, p = 0.014), and patient age (OR = 1.03, p = 0.001) were significant independent predictors of UTI. Furthermore, patients with a urinary bacterial count > 1200/μL had 83 times higher odds of a positive urine culture (OR = 83, 95% CI 32.25-200, p < 0.001). Conversely, CRP levels and gender were not significant predictors (p > 0.05). Patient age, WBC, and neutrophil counts are key factors for predicting UTIs. Integrating these parameters with urine flow cytometry bacterial counts can significantly enhance diagnostic accuracy and rapid screening in clinical practice.

Longitudinal Evolution of Uroflowmetry Patterns From Childhood to Puberty After Hypospadias Repair: A 12-Year Cohort Study.

Benign Prostatic Hyperplasia (BPH) affects more than half of men over age 50, yet current treatment options are limited to medications that cause bothersome side effects or surgical procedures, including minimally invasive surgical therapies (MIST) that involve piercing, cutting, or burning tissue, often leading to discomfort and recovery concerns. The Zenflow Spring System® provides a tissue-preserving alternative that offers symptom relief with quicker recovery and less procedural discomfort. Three single-arm, multicenter, prospective pilot studies with similar trial designs were conducted from 2018-2021 across four countries and data were combined to evaluate the feasibility, safety, and effectiveness of the Spring System in relieving symptoms of obstructive BPH. Men ≥ 45 years with moderate-to-severe symptoms (International Prostate Symptom Score (IPSS )>13), peak urinary flow rate (QMax) between 5 and 15 mL/s, prostate volume between 25 and 80 cc, prostatic urethral length between 25 and 45 mm, and voided volume of at least ≥ 125 mL were enrolled. The primary endpoint was symptom improvement 3 months post-procedure, measured by change in IPSS. Secondary endpoints included IPSS-QoL, and functional improvement measured by Qmax. Follow-up visits occurred through 24 months. Successful implantation of the Spring Implant was achieved in all 72 study participants, with no perioperative serious adverse events. At 3 months, mean change from baseline was -10.71 (95% CI: -12.90, -8.51, p < 0.001) for IPSS, -2.1 (95% CI: -2.61, -1.58, p < 0.001) for IPSS-QoL, and 2.86 (95% CI: 1.68, 4.04, p < 0.001) for Qmax, corresponding to 49%, 47%, and 27% improvements, respectively. These improvements were sustained through 24 months, with 48%, 55%, and 32% improvement relative to baseline in IPSS, IPSS-QoL, and Qmax, respectively. At 24-months, treatment with the Spring System resulted in immediate, significant, and durable improvements compared with baseline, supporting its role as a minimally invasive, tissue-preserving treatment option for men with lower urinary tract symptoms secondary to BPH. NCT03595735, NCT03577236, NCT04309695.

Urinary oxygen tension (PuO2) is a promising continuous biomarker of renal medullary oxygenation, but distal catheter measurements are distorted by transit delay and wall diffusion, especially during oliguria. We developed and validated a physics-based algorithm that reconstructs bladder PuO2 from the distal signal. We formulated complementary steady-state and transient diffusion-transport models that couple wall diffusion to a lumen mass balance and solve an inverse problem to estimate bladder PuO2. Performance was assessed on a bench-top catheter system with controlled flows and in eight swine undergoing hemorrhagic shock and resuscitation (68,788 paired samples). On the bench top, adjustment reduced mean bias relative to bladder PuO2 from - 10.9 to -0.64 mmHg, narrowed 95% limits of agreement from 39.1 to 15.8 mmHg, and improved correlation with ground truth (R2 0.53→0.94). In vivo, pooled bias decreased from + 20.9 ± 11.5 to -4.1 ± 13.5 mmHg and mean absolute error from 21.1 to 9.5 mmHg, with the largest gains at low urinary flow. Modeling transport delay and wall diffusion enables reconstruction of bladder PuO2 from distal catheter measurements, supporting reliable, real-time urinary hypoxia monitoring and broader application to other conduit-based analyte measurements.

Benign prostatic hyperplasia (BPH) is a highly prevalent condition among aging men and a major cause of lower urinary tract symptoms (LUTS). Although α1-adrenoceptor blockers and 5-alpha-reductase inhibitors remain the cornerstone of treatment, their long-term use is frequently limited by adverse effects and suboptimal symptom control. Growing experimental and clinical evidence suggests that chronic prostatic inflammation plays a central role in BPH progression, raising interest in anti-inflammatory compounds such as curcumin. However, the clinical effectiveness of curcumin in BPH remains poorly defined. We conducted a systematic review and meta-analysis of randomized and nonrandomized comparative studies evaluating curcumin versus placebo in men with BPH receiving α-blockers and/or 5-alpha-reductase inhibitors. Searches were performed in PubMed, Embase, and Cochrane CENTRAL. The primary outcome was change in International Prostate Symptom Score (IPSS). Secondary outcomes included prostate-specific antigen (PSA), prostate volume (PV), post-void residual volume (PVR), and maximum urinary flow rate (Q-max). Pooled analyses were performed using a random-effects model. Six studies involving 697 patients met the inclusion criteria. Compared with placebo, curcumin was associated with a significant improvement in IPSS (MD - 4.11; p = 0.0009), accompanied by reductions in PSA (MD - 0.52ng/mL), PV (MD - 3.78mL), and PVR (MD -2.38mL), as well as an increase in Q-max (MD 2.09mL/s). Subgroup analyses suggested greater symptomatic benefit among patients receiving α-blockers alone compared with those on combined α-blocker and 5-alpha-reductase inhibitor therapy. Substantial heterogeneity was observed across outcomes. Curcumin supplementation was associated with significant improvement in LUTS and functional parameters in men with BPH. Although these findings support a potential adjunctive role for curcumin, the available evidence is limited by heterogeneity and study design variability. Well-designed, large-scale randomized trials are warranted to define its clinical utility, optimal formulation, and long-term effects.

Anatomical endoscopic enucleation of the prostate (AEEP) has become an established size-independent standard surgical treatment for benign prostatic hyperplasia. However, evidence regarding treatment of patients with prostate volumes ≥ 200mL remains limited. This review aims to evaluate the available literature on functional outcomes, complications, technical challenges, and alternative surgical approaches in patients with extremely large prostates. A systematic literature search was performed in PubMed/MEDLINE, Web of Science, and Scopus. Studies reporting outcomes of endoscopic enucleation in patients with prostate volumes ≥ 200mL were included. Perioperative outcomes, functional results, complications, and comparisons with alternative surgical techniques were analyzed. The available evidence consists exclusively of retrospective case series from specialized centers. Functional outcomes, including symptom relief, improvement in urinary flow rate, and reduction of post void residual urine, were comparable to those reported for smaller prostate volumes. However, operative and morcellation times were longer, and complication and transfusion rates were increased. Bleeding-related complications were found to correlate with prostate volume. Technical challenges mainly arise from altered anatomy during enucleation and morcellation. In selected cases, staged morcellation, open cystotomy for adenoma retrieval, or temporary perineal urethrotomy may be required. Compared with open simple prostatectomy, AEEP is associated with lower morbidity. Robot-assisted simple prostatectomy represents a potential alternative in experienced centers but has not demonstrated clear functional advantages to date. AEEP is an effective and safe treatment option for prostate volumes ≥ 200mL. Despite greater technical complexity and higher rates of bleeding-related complications, functional outcomes are comparable to those achieved in smaller glands. In experienced hands, AEEP offers the best available evidence while maintaining lower morbidity than alternative surgical approaches. However, current evidence is derived almost exclusively from expert centers, limiting the generalizability of these findings to institutions with less experience.

The urine dipstick is widely used to screen for urinary tract infection (UTI) in daily practice. However, in older adults, especially women, its reliability is limited by the high prevalence of asymptomatic bacteriuria and leukocyturia. Recently, a consensus-based reference standard was introduced to classify patients based on the likelihood of UTI. Using this standard, we assessed the diagnostic accuracy of the urine dipstick in older adults. We performed an observational study using prospectively collected data from two ongoing studies. We included adults aged ≥ 60years with clinically suspected UTI who underwent dipstick testing, urine flow cytometry, and urine culture during the same episode. The Roche COMBUR-7 urine dipstick served as the index test, and episodes were classified using the consensus-based reference standard. We evaluated all possible dipstick thresholds and their combinations, calculating sensitivity, specificity, predictive values, and likelihood ratios using Generalized Estimating Equations to account for multiple episodes per participant. Receiver operating characteristic analysis was performed to determine the optimal balance between sensitivity and specificity. We included 368 episodes from 199 participants (mean age 73.8years; 77.9% women). Dipstick sensitivity was 93.6% (95% CI 90.1%-95.9%) and specificity was 58.6% (95% CI 45.4%-70.6%) for the conventional threshold of nitrite + and/or leukocyte esterase ≥ 1 + . A higher threshold, "total of ≥ 2 + " (leukocyte esterase ≥ 2 + or nitrite positive with leukocyte esterase ≥ 1 +) improved performance, yielding a sensitivity of 82.2% (95% CI 77.0%-86.4%) and a specificity of 75.7% (95% CI 61.6%-85.8%). With this threshold, the positive likelihood ratio improved from 2.3 (95% CI 1.76-3.06) to 3.4 (95% CI 2.0-6.1). In older adults with suspected UTI, urine dipstick testing demonstrates limited diagnostic performance. Current thresholds yield high sensitivity but poor specificity, which may contribute to unnecessary antimicrobial treatment. Given the high prevalence of asymptomatic bacteriuria in older adults, a higher threshold of "total of ≥ 2 + " (either LE ≥ 2 + , or nitrite + combined with LE ≥ 1 +) may improve diagnostic accuracy and be considered when assessing patients ≥ 60years old for antibiotic therapy. Prospective studies are needed to confirm this recommendation.

Genitourinary (GU) trauma occurs in ~10% of polytrauma patients and ranges from immediately life-threatening injuries to delayed complications with significant morbidity. Effective management requires multidisciplinary coordination among trauma surgery, urology, radiology, orthopedics, and critical care teams. Management of renal injury has continued to evolve, and up-to-date application of adjunctive therapy is essential to optimize outcomes. Bladder injury is often associated with pelvic fractures; diagnosis, categorization, and management of urine flow reduces infection and complications. Knowledge of ureteral and urethral injury management principles, strategy, and timing has been shown to reduce long-term complications and morbidity. Genital injuries, while less common and less severe, may be managed using systematic evaluation and intervention to improve functional outcome. Long-term follow-up is critical across all GU injuries to monitor for complications, including hypertension, fistula, stricture, incontinence, sexual dysfunction, and impaired renal function. Early recognition and adherence to structured management principles are essential to optimize outcomes and preserve genitourinary function.

Abstract. The presented clinical case demonstrates the ineffectiveness of delayed feminizing surgery in patients with high urogenital sinus due to congenital adrenal hyperplasia. The first stage of feminization was undertaken at the age of two years. Sinusotomy was performed in combination with clitoroplasty. Infravesical obstruction, hydrocolpos, hydrometra and recurrent urinary tract infection arose as a result а narrow common urogenital canal created. The second stage included introitoplasty with a skin flap. The outflow from the genitals was restored and the obstruction to the flow of urine was eliminated, the urogenital sinus was preserved. As a result of two operations, its persistence continues and maintains the risk of recurrent urinary infection.