1. Female Development UROGENITAL TRACT Female Development RICHARD SCHLUSSEL, M.D. DEPARTMENT OF UROLOGY DIVISION OF PEDIATRIC UROLOGY

2. Normal development Duplication Agenesis UG Sinus Imperforate hymen CAH

9. Paramesonephric duct –A.K.A. Mullerian Duct –Becomes future Fallopian tubes Uterus Upper 2/3 vagina

11. VAGINAL AND UTERINE DUPLICATION

12. Bicornuate Uterus

13. Didelphys uterus

14. Unicornuate Uterus

15. Complete Vaginal Duplication Symptom –Blood persists despite tampon during menses

16. Symptom –Upper vagina fills with blood during menses

18. Mayer-Rokitansky-Küster- Hauser Syndrome 1 in 5,000 births

19. VAGINAL AGENSIS

22. Normal Hymenal Ring

23. Imperforate hymen

24. Mucous due to maternal hormones

25. Intra-op drainage of imperf hymen

26. Ambiguous Genitalia Female Pseudohermaphrodite –Congenital Adrenal Hyperplasia (CAH) 46 XX Normal ovaries, uterus and upper vagina Virilized external genitalia –Due to in utero exposure to testosterone Most common cause of intersex Normal potential for sexual and reproductive function as femalesNormal potential for sexual and reproductive function as females

27. Ambiguous Genitalia Congenital Adrenal Hyperplasia

30. -Nonpalpable testes -Hypospadias - small phallus with curvature -ALERT !!

39. UROGENITAL SINUS

44. Association with Urinary Tract Anomalies –Renal agenesis –Ectopic ureters

45. Albert Einstein “Imagination is more important than knowledge “ "The secret to creativity is knowing how to hide your sources." “It’s not that I was so smart; I just stayed with a problem longer”

46. Hypospadias

47. Hypospadias repair

50. CAH 46 XX