Urinary retention in an adolescent with a history of urethral transection.
BACKGROUND
Urinary retention is rare in adolescence. Here I describe such a case in a patient who had transected her urethra in a motor vehicle accident at 3 years of age. The presumptive diagnosis of urethral stricture was proven incorrect.


OBJECTIVE
Both to present a complicated and unique case whose history pointed strongly to one diagnosis initially but turned out very differently than expected; and to give an example of the use of bedside ultrasonography in the Emergency Department as a diagnostic tool in an unusual circumstance.


METHODS
A 13-year-old girl was evaluated for 3 days of urinary retention. Her history of pelvic fracture and urethral transection in childhood suggested a urethral stricture. Her work-up revealed, however, a vaginal stricture and resultant hematocolpos compressing the urethra. Upon surgical excision, the stricture was confirmed to be scar tissue, rather than a coincidental congenital septum.


CONCLUSIONS
Hematocolpos is an uncommon but well-described cause of urinary retention in premenarchal females. This is a difficult diagnosis in any circumstance, and this patient's complex history complicated the process. It was the bizarre bedside ultrasound that prompted further work-up than simple urethral catheterization and urologic follow-up, which her urologist had suggested over the phone. This patient's case is unique in the literature.
Department of Emergency Medicine, University of Arkansas for Medical Science, Little Rock, Arkansas, USA.
Jeffery W
JW
Steele
D000063:Accidents, Traffic; D000293:Adolescent; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000601:surgery; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006399:Hematocolpos / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D010384:Pelvic Bones / Q000293:injuries; D000267:Tissue Adhesions / Q000473:pathology / Q000601:surgery; D014463:Ultrasonography; D014521:Urethra / Q000293:injuries*; D016055:Urinary Retention / Q000209:etiology* / Q000601:surgery; D014621:Vagina / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery