Female hypospadias presenting with urinary retention and renal failure in an adolescent: uncommon and late presentation with significant hidden morbidity

Abstract

An 11-year-old girl presented with poor urinary stream with vaginal voiding since childhood. She had palpable bladder and raised serum creatinine (671 µmol/L). Suprapubic catheterisation was performed after a failed urethral attempt. Following catheterisation she improved symptomatically. She underwent cystoscopy through the suprapubic portal as a guide wire could be negotiated through bladder neck; external urethral meatus was found as a dimple higher up in anterior vaginal wall. Female hypospadias is usually an incidental diagnosis during catheterisation for various reasons. Diagnosis could be established only after antegrade cystoscopy. Anecdotal cases have been reported in the literature with similar presentation. Early diagnosis is essential as renal failure could be a late presentation if patients continue to void with stenosed meatus. Long-term follow-up is needed as these patients may need definitive management later on.