Clinical examination revealed an abnormal urethral meatus on the anterior vaginal wall, consistent with female hypospadias.

This case demonstrates the classic delayed clinical course of female hypospadias leading to obstructive renal failure. The prenatal findings of renal pelviectasis are mild and nonspecific, and yet the later presentation was dramatic and critical.

Female hypospadias, defined as a female urethra opening on the anterior vaginal wall, is a sneaky congenital urological condition. It is hard to diagnose clinically, and frequently asymptomatic until end-stage renal disease (ESRD) due to lower urological tract obstruction. There have been case reports of female hypospadias diagnosed in teenagers at ESRD.

To our knowledge, this is the first report of prenatal and postnatal correlation.