Intersex

Idiopathic female pseudohermaphroditism with urethral duplication and female hypospadias

Female hypospadias is a rare anomaly of the female urethra where it opens on the anterior vaginal wall anywhere between the introitus and the fornix. It is often associated with other genitourinary anomalies such as Cloacal malformation, female pseudohermaphroditism, nonneurogenic neurogenic bladder and urethral duplication. Idiopathic female pseudohermaphroditism is extremely rare, and most cases occur secondary to adrenogenital syndrome or maternal androgen exposure. We report a unique case of a 1-year and 4-month-old girl who presented with ambiguous genitalia and renal failure secondary to a non-neurogenic neurogenic bladder. On further evaluation, she was found to have urethral duplication with a hypospadiac female urethra. She initially underwent a vesicostomy and was further planned to undergo an appendicular Mitrofanoff at an older age. The mainstay of treatment in these cases includes relief of bladder outlet obstruction and recovery of renal function by adequate urinary drainage. Clitoral reduction, if cosmetically warranted, may be planned at puberty.

Idiopathic female intersex with clitoromegaly and urethral duplication

Idiopathic female intersex presents in the neonate with characteristic anomalies of the external genitalia, complete and separate phallic and vaginal urethras and vesical outlet obstruction. Management of this disorder should initially focus upon adequate urinary drainage and proper sex assignment in the neonate. Successful management and surgical reconstruction of the external genitalia should later result in normal female development.