Complications of the genitourinary system in girls with disorders of sex development and hypospadias

Series of clinical cases demonstrates functional state of lower urinary tract in girls with disorders of sex development (DSD) and hypospadias after the first stage of feminization. The study included 27 girls and women with DSD with hypospadias. Most of them have congenital adrenal hyperplasia (24), fewer girls have partial gonadal dysgenesis (1) and idiopathic virilization (2). Patients were examined before second stage surgical feminization in 1–15 years after the first stage. Concomitant pathology of the urogenital tract was detected in 19 (70%) patients. Urinary tract infection (UTI) was verified in 13 (48%), bladder dysfunction (BD) was diagnosed in 7 (26%), trapped menstrual secretions presented as hematometra, hematocolpos, and urine accumulation and stagnation in the vagina in anamnesis or as a result of preoperative studies were diagnosed in 9 (33%). Combination of the listed complications were observed in five patients (14%). Results of second stage of feminization confirmed connection of hypospadias with listed complications. This were detected in 11 (69%) patients after introitoplasty without separation of urinary and genital tracts (UGT). Introitoplasty with separation of UGT and elimination of hypospadias was complicated only four patients (36%), herewith the UTI and BD were eliminated. Hypospadias in girls with DSD is risk of development such complication as urinary tract infection, trapped menstrual secretions and bladder dysfunction. This circumstance requires change in surgical feminization tactics in girls with DSD, taking into account the anatomical components of genitalia malformations.