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

Oshiba, Ahmed; Ashour, Khaled; Khairi, Ahmed; Shehata, Sameh; El-Sayed, Salah M.; Elhalaby, Essam A.

doi:10.1186/s43159-020-00024-0

Cited by 4 publications

(2 citation statements)

References 24 publications

(38 reference statements)

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“…Surgeons have been more concerned to create a visible separate vaginal orifice in the perineum via sophisticated flaps using a variety of tissues (not necessarily sensitive). Although these techniques have been shown to be feasible, many are not very well reproducible with less satisfactory outcomes; possible complications comprise variable degrees of scaring and fibrosis that can greatly affect function, cosmesis and sometimes continence [13,20].…”

Section: Discussionmentioning

confidence: 99%

Feminizing genitoplasty in childhood: aiming for achievable outcomes

AbouZeid

2020

Ann Pediatr Surg

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Background Early genital reconstruction may be recommended in cases of congenital adrenal hyperplasia to avoid the stigma that can affect these individuals with variable degrees through different cultures. However, the separation and mobilization of a high vagina has remained challenging with less satisfactory surgical outcomes. Therefore, the value of early vaginal reconstruction has been questioned in favour of delaying the whole repair after puberty. In this report, the author has adopted the third option in-between, which comprises early reconstruction of the external genitalia and delaying the more challenging vaginal reconstruction (if needed) to be performed after puberty. Results The study included ten consecutive cases of CAH who underwent feminizing genitoplasty during the period 2016 through 2019. Their age at operation ranged from 8 to 84 months (mean 31; median 15). In five cases (50%), the technique of limited urogenital sinus mobilization adopted in this report succeeded in bringing the vaginal introitus down to the perineum. Those cases had originally a low vagina. In the rest of cases, labial retraction showed a common but wide urogenital introitus perfectly lined by urogenital mucosa. The outcomes have been considered satisfactory to a great extent for both parents and doctors regarding cosmesis and lack of functional complications (voiding problems). Longer follow up is still needed to assess the sexual function when these girls become sexually active. Conclusion In cases of congenital adrenal hyperplasia, reduction clitoroplasty combined with partial urogenital sinus mobilization can achieve predictable and satisfactory outcomes. In about 50% of cases, this approach is sufficient to bring the vagina down to the perineum. In the other half of cases with higher vagina, the possibility of satisfactory sinus intercourse can be studied when these girls grow and become sexually active; otherwise, a delayed vaginal reconstruction may turn to be necessary.

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Section: Discussionmentioning

confidence: 99%

Feminizing genitoplasty in childhood: aiming for achievable outcomes

AbouZeid

2020

Ann Pediatr Surg

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“…A. Oshiba и соавт. считают целесообразным выполнение вагинопластики после наступления пубертатного периода только в тех случаях, когда отмечается сильная гипоплазия влагалища, которую можно исправить только при дополнительном использовании невагинальной ткани [9]. В свою очередь основным преимуществом ранней одноэтапной вагинопластики является то, что возможно использование избытка ткани УГС для реконструкции передней стенки влагалища.…”

Section: лекции для врачейunclassified

Aesthetic Gynecological Surgeries in Children and Adolescents

Sibirskaya,

Karachentsova,

Ivanovskaya

et al. 2023

EPh

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Aesthetic gynecological operations in children and adolescents are aimed at eliminating congenital anomalies of the structure of the external genitalia, which usually occur as a result of a violation of the formation of sex. In addition, operations are often performed to achieve a cosmetic effect in conditions such as hypertrophy of the labia minora, clitoromegaly (not associated with genetic defects), atrophy and narrowing of the entrance to the vagina. At the moment, there is no consensus on at what age to perform aesthetic reconstructive surgery for abnormalities of the development of external genitalia in pediatric patients. At the same time, many techniques have been developed that are actively used in clinics around the world. The article considers the most practical and least traumatic, with a low percentage of complications, methods of plastic surgery in children and adolescents with congenital malformations and cosmetic defects of the external genitalia. A search for literature reviews, systematic reviews, meta-analyses and clinical studies on the topic of aesthetic gynecological operations in gynecology of children and adolescents was conducted in the PubMed and Embase. The search was carried out using combinations of MESH terms: feminizing genitoplasty, atypia of the external genitalia, pediatrics, disorders of sex formation, congenital hyperplasia of the adrenal cortex. The articles were analyzed, the full text of which was in the public domain, with a detailed description of the course and results of the operation, a description of clinical cases and studies in the field of pediatric and adolescent gynecology, mainly surgical treatment of congenital disorders of the reproductive system. As a result of a search in the PubMed, Embase databases with a diverse combination of keywords, 498 publications were found that were screened by name and abstract. 120 articles were selected for full-text analysis, 31 of them were selected for citation.

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