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

Abstract

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.

Anterior Sagittal Approach and Total Urogenital Mobilization for the Treatment of Persistent Urogenital Sinus in a 2-Year-Old Girl

“…This procedure has gained widespread acceptance and has almost entirely replaced the older techniques. 3,14 Unfortunately, in this position the identification of the vaginal confluence is difficult, as well as the perivaginal dissection or the complete release of the vagina from the surrounding tissues. The original description of TUM limited its use to UG sinuses, less than 3 cm long and required discarding the excess sinus tissue 13,15 that inhibits the vagina from reaching the perineum, thereby creating a wide vaginal opening.…”

“…1 It can be an isolated anomaly or associated with external genitalia virilization (congenital adrenal hyperplasia [CAH]), or included in the cloacal anomaly. [2][3][4] Surgery should be tailored to the individual patient according to either the length of the CC (that identifies low and high forms) or to the associated anomalies. Simple flap vaginoplasties are sufficient to treat low UGS, whereas high forms require a more extensive dissection and a subsequent pull-through.…”

“…Simple flap vaginoplasties are sufficient to treat low UGS, whereas high forms require a more extensive dissection and a subsequent pull-through. 3,4 This can be obtained by prior separation of the vagina and urethra (by the posterior sagittal transanorectal approach [PSTA] or the anterior sagittal transrectal approach [ASTRA]) or by an en bloc procedure (total urogenital mobilization [TUM]). What we are reporting in this article is a modified technique combining the advantages of these two approaches which was performed on a patient with high UGS related to CAH.…”

Urogenital Sinus with Mitrofanoff Procedure: Case Review

“…It involves removing strips of tissue from the intestinal tract and adding this to the tissue of the bladder. 1 This has two intended results: increased bladder volume and a reduced percentage of the bladder involved in contraction that in turn results in lower internal pressures in the bladder during urination 5 (►Fig. 3).…”

“…Urogenital sinus can occur due to various reasons such as iatrogenic causes, obstructed labor, trauma, and infections. 1…”