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Case Reports
. 2025 Aug 6:62:103146.
doi: 10.1016/j.eucr.2025.103146. eCollection 2025 Sep.

Pull-through vaginoplasty with anterior sagittal transrectal approach in high confluence urogenital sinus and 46XX, DSD: A case report and literature review

Angger Satria Pamungkas  1 , Gerhard Reinaldi Situmorang  1 , Muhammad Ridha  1 , Irfan Wahyudi  1
Affiliations
Case Reports

Pull-through vaginoplasty with anterior sagittal transrectal approach in high confluence urogenital sinus and 46XX, DSD: A case report and literature review

Angger Satria Pamungkas et al. Urol Case Rep. .

Abstract

We report our experience of pull-through vagina with anterior sagittal approach of high. UGS in 46,XX disorder of sex development (DSD). Rare case of 4-year-old girl presented with UGS and 46,XX DSD with the chief complaint of purulent urination since 2 years ago. Patient underwent pull-through vaginoplasty with anterior sagittal approach. Surgical wound was in good condition, there was no leakage and urine production on both urethral catheter and cystostomy was good. Pull-through vagina with anterior sagittal approach is feasible procedure, which provides excellent exposure and easy identification of the vaginal confluence for UGS patient.

Keywords: Anterior sagittal approach; Case report; Pull-through vagina; Urogenital sinus.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Clinical appearance before surgery (A). Appearance of attached cystostomy (B).
Fig. 2
Fig. 2
. Magnetic resonance imaging of the whole abdomen with contrast: sagittal section (A and B) and axial section (C and D) showing high confluence of the urogenital sinus.
Fig. 3
Fig. 3
. Endoscopic evaluation showing that the distance from bladder neck to vagina is 1.5 cm (A); modified prone position (B); the vagina (V) was dissected to the branching point with the urethra (U), then pull-through vaginoplasty with anterior sagittal transrectal approach (ASTRA) was performed (C and D); completed procedure (E).
Fig. 4
Fig. 4
. Voiding cystourethrogram: bladder filled with 60 mL contrast (A), grade 3 left VUR identified (B), contrast-filled pelvicalyceal system (C).
See this image and copyright information in PMC

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