The Articulations of Adam's Rib with the Lower Urinary Tract

In 1984, a 23-year-old mentally retarded woman with a history of ambiguous genitalia and being raised initially as a boy was admitted for evaluation of a pelvic mass. She had undergone surgery at age 4 for urinary difficulties and was reassigned to female gender. The patient developed hirsutism and acne at age 12, and at age 20, was diagnosed with chronic pyelonephritis, bilateral double collecting system, left hydronephrosis, and hydroureters. A pelvic mass was intermittently palpable and not visible on an intravenous pyelogram (IVP). Physical examination revealed features such as low-set ears, a broad chest without breast development, and male-pattern body hair. Laboratory tests showed normal vital signs, blood count, serum creatinine level (0.8 mg/dl), creatinine clearance (130 liter/24 hr), and adrenal steroids.