Complete corporeal preservation clitoroplasty: new insights into feminizing genitoplasty

Abstract

Introduction: 46,XX Congenital adrenal hyperplasia (CAH) remains the fi rst cause of genital virilization and current surgical techniques aim to restore female aspect of genitalia while preserving dorsal neurovascular bundle but not at the expense of not preserving erectile tissue. We aim to report our experience with a new surgical technique for clitoroplasty, completely preserving corporeal bodies, neurovascular bundles without dismembering the clitoris, in four patients with over a year follow up. Materials and Methods: After IRB approval four patients with 46,XX CAH and Prader 5 and 3 external genitalia, underwent feminizing genitoplasty. Complete preservation of erectile tissue was accomplished without a need to dissect dorsal neurovascular bundle. Glans size allowed no need for glanular reduction and there was no need to dismember the corporeal bodies.Results: Four patients 12 to 24-months-old underwent complete corporeal preservation clitoroplasty (CCPC), mean age was 18.5 months, mean follow up was 10.25 months. Vaginoplasty was performed in all patients with partial urogenital mobilization (PUM) and Urogenital Sinus fl ap (UF), only one severely virilized patient required a parasagittal pre-rectal approach to mobilize the vagina. We had no complications until last follow up. Conclusion: To our knowledge, we are introducing the concept of CCPC without the need of disassembling the corporeal bodies, neurovascular bundle and glans. It stands as a new alternative for feminizing genitoplasty with complete preservation of erectile tissue and no dissection of neurovascular bundle. Although there is still lacking longterm follow-up, it represents a new step in conservative reconfi guration of the external virilized female genitalia.

Perioperative Characteristics and Postoperative Complications of Pediatric Clitoral Reconstruction

“…These results may be attributed to a deep understanding of anatomy and function of the clitoral tissue, especially with respect to the neurovascular bundles, which allow for preservation of the organ. 20 Various techniques have been described to correct clitoromegaly. 21 Fernandez et al, have introduced a complete corporeal preservation clitoroplasty by sparing the corpora cavernosa erectile tissue of the clitoris without disassembling the clitoris and leaving the dorsal neurovascular bundle untouched.…”

“…21 Fernandez et al, have introduced a complete corporeal preservation clitoroplasty by sparing the corpora cavernosa erectile tissue of the clitoris without disassembling the clitoris and leaving the dorsal neurovascular bundle untouched. This procedure kept clitoral erections, sensitivity and vascularity to the clitoris unharmed 20 . In support of the data presented in this study, Jun et al, have shown that pediatric clitoral reconstruction in patients with congenital adrenal hyperplasia (CAH) yielded minimal perioperative complications in Seoul, Korea.…”

Evaluation of the surgical and functional outcomes of secondary vaginoplasties with free skin mesh graft in patients following transfeminine genital reconstructive surgery

“…Previous studies also have reported the use of fullthickness skin, myocutaneous grafts, or peritoneal vaginoplasty with more extensive donor areas (10)(11)(12)(13). However, in these patients, the scars often became more visible, associated with contractures and deformities of abdominal skin.…”