The urethra and vagina are separate anatomical entities in normal females. But in rare instances, they are joined in what urologists call a urogenital sinus anomaly. The following information can help you talk to your child's urologist about correcting this rare birth defect.
What are urogenital sinus abnormalities?
A urogenital sinus anomaly is a defect present at birth in which the vagina and urethra open into a common channel, rather than separately. There are two general types of urogenital sinus anomalies. In a low confluence urogenital sinus anomaly, the common channel is short, the urethral opening is close to its normal location and the vagina is almost normal in length. In a high confluence urogenital sinus anomaly, the common channel is long, the urethral opening is internal and the vagina is quite short. This type is sometimes associated with an anus that is located too far forward.
How are urogenital sinus abnormalities diagnosed?
Urogenital sinus malformations are usually diagnosed during infancy by physical examination. If a urogenital sinus defect is suspect in an infant, an examination called a genitogram will be performed. To do a retrograde genitogram, contrast dye will be injected into the common opening. An X-ray will then be taken which will permit the doctors to determine the length of the common channel and the spatial relationship between the urethra and the vagina. This information will allow the urologist to determine the type of urogenital sinus anomaly and implement the appropriate treatment.
If a retrograde genitogram is inadequate, endoscopy may be done. In endoscopy, a fiber-optic camera is inserted into the common channel, which will allow the anatomy to be seen and identified. Other tests used under special situations include an ultrasound and MRI.
How are urogenital sinus abnormalities treated?
Surgery to separate the vagina and urethra is the only treatment for urogenital sinus abnormalities. Since there are many procedures for this operation, you and your child's doctor will decide the best approach, depending on the type of anomaly. If your child is diagnosed with a low confluence urogenital sinus anomaly, the surgeon will perform what is known as a flap vaginoplasty – a procedure to open the sinus so that the vagina and urethra have separate exterior openings. If she has a high confluence urogenital sinus anomaly, the surgeon will perform a pull-through vaginoplasty. In this procedure the vagina is brought to its normal location on the surface of the skin while the urethra continues to drain through what was once the common channel. Sometimes, a piece of skin or a section of bowel may be needed for this procedure.
Frequently asked questions:
Will my daughter have control over urination?
If the problem is corrected, urination should be normal.
Will my daughter have a normal sex life?
Yes, once the disorder has been corrected, she will be able to have a normal, enjoyable sex life.
Will she be able to have children?
Yes, once corrected, she should have no problem conceiving or bearing children.
Will she have a normal vaginal delivery?
Yes, she should be able to deliver children normally.