Feminizing genitoplasty in congenital adrenal hyperplasia: the value of urogenital sinus mobilization

Abstract

Background/purpose Congenital adrenal hyperplasia is a common cause of ambiguous genitalia in female individuals. These patients require feminizing surgery aiming at reconstruction of feminine external genitalia with normal function. Total urogenital mobilization was developed to avoid dissection in the common wall between the vagina and urethra. This study aims at evaluating the outcome of feminizing genitoplasty after the use of urogenital mobilization.
Patient and methods Fourteen female patients with congenital adrenal hyperplasia were managed during the period from July 2007 to April 2011. They were assessed clinically according to the Prader score. The common channel anatomy was studied by a flush retrograde genitogram. Clitoroplasty, vaginoplasty, and labioplasty were performed. The common sinus was managed by urogenital mobilization. Postoperative cosmetic outcome was evaluated according to the criteria described by Creighton and colleagues. Follow-up included clinical assessment of the urethral and vaginal openings and clinical evaluation of the continence for urine.
Results A genitogram has a sensitivity of 64.3% in estimating the length of the common channel. The length of common channel is not related to the degree of virilization. Good cosmetic outcome was reported in 71.4% of cases. All postoperative complications were minor and managed by simple maneuvers. All patients had good urinary control after urogenital mobilization.
Conclusion Urogenital sinus mobilization is a valuable tool in the early one-stage feminizing surgery with few technical problems, good cosmetic outcome, low incidence of complications, and good urinary continence.

Keywords: congenital adrenal hyperplasia, feminizing genitoplasty, urogenital sinus mobilization