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

Objective To define the neonatal management and ultimate surgical correctio n via the anterior sagittal transanorectal approach (ASTRA) in cases of neo natal urinary hydrometrocolpos associated with a persistent urogenital sinu s (UGS). Patients and methods We report three patients with UGS (with no ambiguous g enitalia) and urinary hydrometrocolpos in whom prenatal ultrasonography sho wed cystic dilatation of the pelvis. Two patients were temporarily treated with intermittent vaginal catheterization and antibiotic prophylaxis, and i n 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 va gina was dilated briefly with no anaesthesia in each patient. Patients had normal faecal control after the colostomy was closed and none had urinary i ncontinence. Conclusions When possible, intermittent vaginal catheterization permits suf ficient temporary drainage of the urinary hydrometrocolpos associated with a persistent UGS. Subsequent ASTRA allows good exposure of the UGS, assurin g the preservation of the anorectal innervation and of the sphincteric mech anism.