Objective: To highlight the unusual and late presentation of the rare congenital urethral anomaly of female hypospadias and its management.
Patients and methods: We report on four cases (aged 18-65 years; mean 34 years and 3 months) of female hypospadias; two presented with urinary incontinence, recurrent UTI since birth and dyspareunia, and two were diagnosed during catheterization following retention of urine. One of the younger patients had vaginal stones. We reached the diagnosis by catheterization, voiding cysto-urethrogram and panendoscopy. A periurethral vaginal flap urethroplasty was performed in three layers with excellent results in three cases, and one patient was managed conservatively.
Results: Results were excellent in the three cases treated surgically. Patients were continent after urethroplasty and were happy to pass urine in a stream with complete emptying of the bladder for the first time in their life. Two of them had fertility problems due to urogenital septal defects and are undergoing appropriate treatment.
Conclusions: Vaginal voiding leads to urinary stagnation in the vagina causing urinary pseudo-incontinence and vaginal stones. Early diagnosis requires a high index of suspicion.