Total and Partial Urogenital Mobilization: Focus on Urinary Continence

Palmer, Blake; Trojan, Brandon; Griffin, Katie; Reiner, William G.; Wisniewski, Amy B.; Frimberger, Dominic; Kropp, Bradley P.

doi:10.1016/j.juro.2011.12.012

Cited by 41 publications

(13 citation statements)

References 17 publications

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“…The mean age at surgery (22 months) in this series is comparable to recent reports of a mean age of 15-19 months [16,17,18]. To date, the consensus statement on the management of intersex disorders considers that childhood genital surgery is indicated in children with a higher degree of genital ambiguity to avoid the assumed psychological distress of passing through childhood and adolescence with abnormal-looking genitalia [32,33,34].…”

Section: Discussionsupporting

confidence: 75%

See 1 more Smart Citation

Timing and Outcome Concerns regarding Feminizing Genitoplasty from the Perspective of Egyptian Families of Girls with Virilized External Genitalia

Marei¹,

Fares

Musa

et al. 2015

Horm Res Paediatr

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Background: Congenital adrenal hyperplasia in females leads to virilization of external genitalia and persistent urogenital sinus. There are controversies regarding the timing and outcomes of surgery. Deferring surgeries beyond childhood is difficult to implement in conservative societies, and may result in stigmatization and distress to individuals with disorders of sexual differentiation and their families. Methods: Thirty girls with virilization due to congenital adrenal hyperplasia were admitted for single-stage feminizing genitoplasty, between 2011 and 2014. We prospectively studied the concerns and input of the families represented by the mothers. After comprehensive counselling, the mothers completed a questionnaire to clarify their priorities and concerns related to surgery. Results: Surgeries were performed at a mean age of 22 months. Most cases ranged between Prader's degrees III and IV. Egyptian families believe that early surgical reconstruction is in the best interest of their girls. They are marginally more concerned about functional outcomes and future child bearing than external appearance and cosmetic outcomes. Conclusions: Social difficulties noticeably add challenges to the management plan within conservative societies. Early genital reconstructive surgery, when reasonably indicated, needs to remain a viable option. Comprehensive psychosocial support within a multidisciplinary approach is needed to defer feminizing genitoplasty in selected cases to adolescence.

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Section: Discussionsupporting

confidence: 75%

“…These techniques are more anatomically adjusted, and have proved intermediate-term favourable outcomes, at least regarding the urinary continence and voiding function, as they preserve the urethral length above the confluence [15,16,17,18]. …”

Section: Introductionmentioning

confidence: 99%

Timing and Outcome Concerns regarding Feminizing Genitoplasty from the Perspective of Egyptian Families of Girls with Virilized External Genitalia

Marei¹,

Fares

Musa

et al. 2015

Horm Res Paediatr

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“…64,65 There is some concern that aggressive mobilisation anterior to the bladder neck and release of the pubovescical ligament could result in incontinence. 66 Patients suspected of having this issue are likely to have global urinary incontinence (constant leaking throughout the day without urgency or frequency symptoms) and should be referred to a urologist for comprehensive assessment.…”

Section: Female Specific Issues In Classic Congenital Adrenal Hyperplmentioning

confidence: 99%

Management of adolescents with congenital adrenal hyperplasia

Merke

Poppas

2013

The Lancet Diabetes & Endocrinology

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The management of congenital adrenal hyperplasia involves suppression of adrenal androgen production, in addition to treatment of adrenal insufficiency. Management of adolescents with congenital adrenal hyperplasia is especially challenging because changes in the hormonal milieu during puberty can lead to inadequate suppression of adrenal androgens, psychosocial issues often affect adherence to medical therapy, and sexual function plays a major part in adolescence and young adulthood. For these reasons, treatment regimen reassessment is indicated during adolescence. Patients with non-classic congenital adrenal hyperplasia require reassessment regarding the need for glucocorticoid drug treatment. No clinical trials have compared various regimens for classic congenital adrenal hyperplasia in adults, thus therapy is individualised and based on the prevention of adverse outcomes. Extensive patient education is key during transition from paediatric care to adult care and should include education of females with classic congenital adrenal hyperplasia regarding their genital anatomy and surgical history. Common issues for these patients include urinary incontinence, vaginal stenosis, clitoral pain, and cosmetic concerns; for males with classic congenital adrenal hyperplasia, common issues include testicular adrenal rest tumours. Transition from paediatric to adult care is most successful when phased over many years. Education of health-care providers on how to successfully transition patients is greatly needed.

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“…Studies comparing TUM for cloacal repair and for congenital adrenal hyperplasia and isolated urogenital sinus have also shown that TUM itself does not trigger impairment of urodynamic and functional outcomes. 15,16 TUM includes ligation of the suspensory ligaments of the bladder. 3 Thus, lowering of the bladder neck, possibly below the pelvic floor, is the major drawback of this technique for urological outcome.…”

Section: Discussionmentioning

confidence: 99%