Case Report: Persistent urogenital sinus (PUGS) associated with complete bicorporeal uterus, double cervix and partial longitudinal non-obstructing vaginal septum: a one-stop diagnostic and operative hysteroscopic approach.

Introduction: Persistent urogenital sinus (PUGS) is a rare congenital malformation characterized by the confluence of the urethra and vagina into a single distal channel. It may be associated with other congenital anomalies, including Müllerian malformations. Although typically diagnosed in childhood, delayed diagnosis may occur, particularly in patients with mild or nonspecific symptoms. Case presentation: We report the case of a 39-year-old nulliparous woman referred for suspected complex genital malformation, presenting with chronic pelvic pain, dyspareunia, and recurrent urogenital infections. A one-stop diagnostic and operative approach, combining transvaginal ultrasound and hysteroscopy, identified PUGS associated with a complete bicorporeal uterus, double cervix, and partial longitudinal non-obstructing vaginal septum (U3bC2V1 according to the ESHRE/ESGE classification). A 15-Fr bipolar mini-resectoscope was used for incision of the vaginal septum and removal of a concomitant FIGO type 0 fibroid in the right hemiuterus. The procedure was completed without complications. Discussion: The integration of expert ultrasound and endoscopic evaluation enabled accurate anatomical characterization and guided tailored surgical management. The use of a 15-Fr bipolar mini-resectoscope allowed effective treatment in a complex anatomical setting, avoiding cervical dilation while providing adequate maneuverability and simultaneous cutting and coagulation. Conclusion: A one-stop approach in a specialized center may improve diagnostic accuracy and support safe, individualized minimally invasive management of complex congenital urogenital anomalies.