Bladder After Total Urogenital Mobilization for Congenital Adrenal Hyperplasia and Cloaca—Does it Behave the Same?

Camanni, Daniela; Zaccara, Antonio; Capitanucci, Maria Luisa; Mosiello, Giovanni; Iacobelli, Barbara Daniela; Gennaro, M. De

doi:10.1016/j.juro.2009.02.067

Cited by 23 publications

(7 citation statements)

References 17 publications

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“…None of them showed any abnormalities in the urodynamics even the patient who was complaining of daytime incontinence and improved few months later. Zaccara et al [25] in his study comparing CAH and cloaca regarding the bladder function showed also no abnormalities in the urodynamics in the group of CAH.…”

Section: Discussionmentioning

confidence: 86%

Evaluation of the early outcomes of partial urogenital sinus mobilization in females with congenital adrenal hyperplasia

et al. 2020

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Background Congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia with an incidence of 1 in 15,000 live births. Surgical reconstruction for girls with CAH and urogenital sinus (UGS) is a great challenge to create normal appearing and functional external genitalia. The purpose of this study is to evaluate the early outcomes of using partial urogenital sinus mobilization in feminizing genitoplasty in females with congenital adrenal hyperplasia regarding vaginal caliber, urinary continence, and genital appearance. Results Patient age at surgery ranged from 4 to 96 months (mean 19.4 months), with a mean follow-up of 15 months. Degree of virilization was Prader type III in 2 children (8%), type IV in 18 (72%), and type V in 5 (20%). Urogenital sinus length was 2.5 cm or less in 18 children. Cosmetic results were good in 19 patients (76%) and satisfactory in 6 (24%). Adequate caliber of the mobilized vagina was achieved in 24 patients (96%). Seven toilet trained children were assessed for bladder function. Only 1 patient was daytime incontinent and improved after few months with regular voiding. Urodynamics was done in toilet trained children and showed normal results. Conclusions The surgical procedure in general is consisting of clitoroplasty, labioplasty, urethroplasty, and vaginoplasty. Separation of the vagina from the urethra is a highly challenging surgical step and need good experience to perform. Partial urogenital sinus mobilization (PUM) has good results regarding the urinary continence, vaginal diameter, and cosmetic results in CAH patients.

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Section: Discussionmentioning

confidence: 86%

Evaluation of the early outcomes of partial urogenital sinus mobilization in females with congenital adrenal hyperplasia

et al. 2020

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“…Similar to Ludwikowski et al (6), they used a posterior skin flap to augment the circumference of the vaginal introitus and to avoid a circumferential suture line. Camanni et al followed six girls with CAH corrected by TUM and found no instances of bladder dysfunction or incontinence (15). In prospective report by Braga et al (16) of 24 girls with CAH operated at a mean age of 28 months and a mean follow-up of 25 months, no cases of urinary incontinence or vaginal stenosis were encountered.…”

Section: Resultsmentioning

confidence: 99%

The Surgical Correction of Urogenital Sinus in Patients with DSD: 15 Years after Description of Total Urogenital Mobilization in Children

Ludwikowski

González

2013

Front. Pediatr.

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Total urogenital sinus mobilization has been applied to the surgical correction of virilized females and has mostly replaced older techniques. Concerns have been raised about the effect of this operation on urinary continence. Here we review the literature on this topic since the description of the technique 15 years ago. Technical aspects and correct nomenclature are discussed. We emphasize that the term “total” refers to an en-bloc dissection and not to the extent of the proximal dissection. No cases of urinary incontinence have been reported following this operation. It is yet too early to evaluate results regarding sexual function but it is likely that the use of a posterior skin flap to augment the introitus will minimize the development of introital stenosis.

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“…This is in contrast with majority of children needing CIC (>40%) in the literature. [3456789] The rest are voiding normally with no deterioration of the upper tracts. Almost all of the eight Group I children needing CIC have major congenital anomalies of the urinary/neural systems, and only in one, the problem has appeared postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Urogenital management in cloaca: An alternative approach

Bal

Sen

Sam

et al. 2017

J Indian Assoc Pediatr Surg

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Introduction:In the management of cloaca, there is concern that dissection of the urogenital sinus in early childhood with the aim of total anatomical correction is hazardous. Avoiding such mobilization and providing mitrofanoff channel, when needed, till peripubertal period reduces complications and is technically easier.Materials and Methods:Forty-three cases of cloaca were managed in the period 2004–2016. Case records and radiology were reviewed retrospectively. The follow-up evaluation was done by looking into voiding history, bowel movements, and menstruation history.Results:There were three groups of children, namely, those with no reconstruction done elsewhere except a diverting fecal stoma (Group I, n = 25), those who had undergone anorectal correction elsewhere with no attempt at urogenital reconstruction (Group IIA, n = 13), and those with attempted bowel and genitourinary reconstruction elsewhere (Group IIB, n = 5). The Group I children (one still awaiting reconstruction) underwent early rectal reconstruction followed by expectant management of the urogenital apparatus. The 18 referred cases had multiple problems, chiefly urogenital, of congenital or iatrogenic origin. While urinary reconstruction included bladder augmentation, ileal neobladder, bladder neck closure, and ureteric reimplantation, the foundation of urinary management was intermittent catheterization through mitrofanoff stoma and the avoidance of any dissection of the cloacal common channel. Surgery on the genital tracts included drainage of hydrocolpos, perineal surgery for low vaginae and abdominoperineal vaginoplasty for high vaginae in the peripubertal period with or without bowel supplementation. Spontaneous voiding was maintained in 17 of 25 (68%) Group I girls (including one death later from intestinal complications), 7 of 13 (54%), Group IIA girls, and 1 of 5 (20%) Group IIB girls. Painless menstruation was noted in eight postpubertal girls, three through the cloacal channel (awaiting reconstruction) and five through the reconstructed vagina. Most of the children are on a bowel management program for fecal cleanliness with washouts through the neoanus or Malone's stoma.Conclusion:We report a nonconventional approach to cloaca based on avoiding dissection of or around the common channel for urethrovaginal reconstruction, opting for mitrofanoff stoma for intermittent catheterization, when needed, and late vaginal reconstruction. We believe this approach has reduced the overall need for intermittent catheterization.

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Bladder After Total Urogenital Mobilization for Congenital Adrenal Hyperplasia and Cloaca—Does it Behave the Same?

Cited by 23 publications

References 17 publications

Evaluation of the early outcomes of partial urogenital sinus mobilization in females with congenital adrenal hyperplasia

Evaluation of the early outcomes of partial urogenital sinus mobilization in females with congenital adrenal hyperplasia

The Surgical Correction of Urogenital Sinus in Patients with DSD: 15 Years after Description of Total Urogenital Mobilization in Children

Urogenital management in cloaca: An alternative approach

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