Abstract
Purpose
We reported the use of the mucosal layer of preputial skin to give extra length to penile flaps on vaginal introitus and labia minora reconstruction in children with congenital adrenal hyperplasia.
Materials and methods
Since November 1999, 14 patients (average age 16 months, range 6 months–4 years) have undergone early one-stage reconstruction of external genitalia. All patients were classified according to Prader’s classification (from III to V degree) with clitoral size of 3 ± 1.5 cm. The perineal sagittal approach is followed by careful dissection and partial mobilisation of the urogenital sinus. Subcutaneous reduction clitoroplasty has been performed. The mucosal layer of the prepuce, developed as an extended flap on the end of the phallic shaft skin used for labia minora, is ideally placed for reconstruction of the vestibulae and distal vagina.
Results
The vagina was calibrated, the main vaginal calibre was 10 Hegar (range 6–14). With one exception, the urethral meatus was situated in the vestibulae and easily accessible. One distal vaginal stenosis was observed in a case with high confluence. No urinary incontinence was noted. The appearance of external genitalia was very satisfactory.
Conclusions
The described genitoplasty provides a good cosmetic appearance. As most of our patients have not yet reached the age of sexual activity and child bearing, the functional results of this operation will need longer-term evaluation.
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References
Creighton SM (2004) Long-term outcome of feminilisation surgery: the London experience. BJU Int 93:44
Spence HM, Allen TD (1973) Genital reconstruction in the female with the adrenogenital syndrome. Br J Urol 45(2):126–30
Creighton SM (2008) Sexual function and genital sensitivity following feminizing genitoplasty for congenital adrenal hyperplasia. J Urol 179:634–638
Krege S, Walz KH, Hauffa BP, Korner I, Rubben H (2000) Long-term follow-up of female patients with congenital adrenal hyperplasia from 21-hydroxylase deficiency with special emphasis on the results of vaginoplasty. BJU Int 86:253
Pippi Salle JL (2007) Corporeal sparing dismembered clitoroplasty: an alternative technique for feminizing genitoplasty. J Urol 178:1796–1801
Rink RC et al (2006) Use of the mobilized sinus with total urogenital mobilization. J Urol 176:2205–2211
Mininberg DT (1982) Phalloplasty in congenital adrenal hyperplasia. J Urol 128(2):355
Hendren WH, Donahoe PK (1980) Correction of congenital abnormalities of the vagina and perineum. J Pediatr Surg 15(6):751
Jones HW, Wilkins L (1961) Gynecological operation in 94 patients with intersexuality. Am J Obst Gynecol 82:1142
Passerini-Glazel G (1989) A new one-stage procedure for clitorovaginoplasty in severely masculinized female pseudohermafrodites. J Urol 142(2 Pt 2):565
Gonzales R, Fernandes ET (1990) Single-stage feminization genitoplasty. J Urol 143(4):776
Pena A, Filmer B, Bonilla E, Mendez M, Stolar C (1992) Transanorectal approach for the treatment of urogenital sinus: preliminary report. J Pediatr Surg 27(6):681
Domini R, Rossi F, Ceccarelli PL, De Castro R (1997) Anterior sagittal transano-rectal approach to the urogenital sinus in adrenogenital syndrome: preliminary report. J Pediatr Surg 32(5):714
Rink RC, Pope JC, Kropp BP, Smith ER Jr, Keating MA, Adams MC (1997) Reconstruction of the high urogenital sinus: early perineal prone approach without division of the rectum. J Urol 158(3 Pt 2):1293
Savanelli A (2001) A modified approach for feminizing genitoplasty. 12° ESPU Meeting, Aarhus BJU International:45
Acknowledgments
The authors thank Ms Anna Maria D’ Oro for her expert technical assistance.
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Savanelli, A., Alicchio, F., Esposito, C. et al. A modified approach for feminizing genitoplasty. World J Urol 26, 517–520 (2008). https://doi.org/10.1007/s00345-008-0298-4
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DOI: https://doi.org/10.1007/s00345-008-0298-4