An unusual cause of incontinence: urethral coitus

Megalourethra and bladder foreign body in a female patient

Key Clinical Message

Undiagnosed female megalourethra can be a cause of iatrogenic bladder foreign body.

Abstract

Foreign bodies in the urinary bladder are relatively rare. Female megalourethra is an extremely rare congenital disorder which is usually associated with Müllerian anomalies. We describe a case of an iatrogenic bladder foreign body and a megalourethra in a young woman with normal gynecological organs.

An Unusual Cause of Female Urinary Incontinence Following Obstetric Trauma

Urethral coitus is a rarely reported cause of female urinary incontinence and has been most commonly described in women with vaginal and hymenal anomalies. Herein, we report a 41-year-old woman with a complex obstetric history, who presented with continuous urinary incontinence. On evaluation, she was found to have an abnormally dilated urethral orifice and vaginal stenosis suggestive of chronic urethral coitus. She underwent a reduction urethroplasty with autologous sling insertion and a vaginoplasty using vaginal flaps. This case highlights the fact that urethral coitus, though rare, should be considered as a cause of urinary incontinence in women with history of obstetric vaginal trauma.

Urethral Coitus in a Case of Vaginal Agenesis - Is Only Vaginoplasty Enough to Treat the Urinary Problems?

Urethral coitus is an extremely rare condition. Megalourethra and urinary incontinence due to urethral coitus in vaginal agenesis are unusual manifestations because these patients usually present with primary amenorrhea before becoming sexually active and receive treatment. A 24-year-old woman came to our clinic because of primary amenorrhea, sexual dysfunction, dyspareunia, megalourethra and urinary incontinence five months after her marriage due to urethral coitus. Based on these clinical and radiological findings a diagnosis of Mayer-Rokitansky-Kuster-Hauser Syndrome was made and patient underwent modified McIndoe Vaginoplasty. The elasticity of female urethra permits repeated coitus, together with the physical damage can probably lead to incontinence. In this case, after eliminating the underlying cause of disease with vaginoplasty, no other treatment was required. The integrity of sphincteric function and structural support of urethra might be regained without subjecting the patient to aggressive reconstructive surgical procedures.

Adolescent urethral coitus: 2 cases and review of the literature

BACKGROUND

Urethral coitus is a very rare finding in adolescent women. There are 26 reported cases in the literature, but only two were in adolescents. Urethral coitus has been most commonly described in women with müllerian anomalies and less commonly in other unusual clinical circumstances.

CASES

We report 2 cases of adolescent women with known müllerian anomalies who were unknowingly engaging in urethral coitus; 1 adolescent with known vaginal agenesis and VACTERL association and one 16-year-old with an oblique vaginal septum and non-communicating functioning uterine horn. Both young women had significant urethral dilation at the time of examination under anesthesia.

CONCLUSIONS

Urethral intercourse is rare but may have significant consequences. Ongoing follow-up, careful history, and physical examination in adolescent women with müllerian anomalies are important in order to avoid possible complications, particularly when they are contemplating sexual activity. A history of urinary incontinence, dyspareunia, and urinary tract infections in young women with müllerian anomalies should raise suspicion of urethral coitus. If possible, the müllerian anomaly should be corrected to allow vaginal intercourse and discontinuation of urethral coitus.

Bowel evisceration through the bladder neck in a paraplegic female secondary to urethral coitus

INTRODUCTION

Urethral coitus is rarely reported in the literature. The majority of reported cases have been secondary to vaginal agenesis or hymenal anomalies.

AIM

We report a case of urethral coitus in a paraplegic patient with a patulous urethra resulting from chronic indwelling catheter use, with the unfortunate presentation of bladder rupture and evisceration per urethra. To our knowledge, this is the only report of urethral coitus due to sequelae from an indwelling catheter, as well as the only report of the subsequent complication of bowel evisceration per urethra.

RESULTS

After initial temporization at an outside facility, we were able to perform primary cystorrhaphy. There was no need for bowel resection. The patient has chosen to defer her decision on permanent reconstruction.

CONCLUSIONS

Urethral coitus is rare and the subsequent ramifications can be devastating, particularly in neurologically impaired patients. This unusual case speaks to the importance of properly caring for the neurogenic bladder.

Urethral coitus in a patient with a microperforate hymen

Microperforate hymen is a rare condition consisting of a tiny hymeneal orifice with normal female genitals. A woman had microperforate hymen in which diagnosis and treatment was performed after decades of urethral coitus.

Female urethral and bladder neck injury after rape: an appraisal of the surgical management

The aim of this study was to discuss the surgical management of urethral and bladder neck injury after urethral coitus during rape. A 21-year-old lady presented with total urinary incontinence of 1-year duration after being raped. On examination, she had urethral laceration and a patulous urethra and bladder neck suggesting urethral coitus during the rape. Her introitus and vagina were however normal. She had repair of her urethral laceration and plication of her urethra and bladder neck via a vaginal approach. She regained her continence and voids without any residual urine. Urethral coitus is rare. Urethral coitus in the presence of a normal introitus and vagina is very rare. The urethral and bladder neck injury resulting from this can be satisfactorily corrected by urethral and bladder neck plication via a vaginal approach with the vaginal incisions positioned to forestall suture line apposition, which may lead to wound failure.