Vaginal Reconstruction after Initial Construction of the External Genitalia in Girls With Salt-Wasting Adrenal Hyperplasia

Bailez, Marcela; Gearhart, John P.; Migeon, Claude J.; Rock, John A.

doi:10.1016/s0022-5347(17)36691-0

Cited by 87 publications

(41 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Vaginal mobilization is also limited and the pull-through to the perineum is often under tension. This can predispose to stenosis of the vaginal opening; thus several calibrations are necessary during the follow-up period [27,32].…”

Section: Discussionmentioning

confidence: 99%

The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus

et al. 1999

View full text Add to dashboard Cite

Objective To de®ne the neonatal management and ultimate surgical correction via the anterior sagittal transanorectal approach (ASTRA) in cases of neonatal urinary hydrometrocolpos associated with a persistent urogenital sinus (UGS). Patients and methods We report three patients with UGS (with no ambiguous genitalia) and urinary hydrometrocolpos in whom prenatal ultrasonography showed cystic dilatation of the pelvis. Two patients were temporarily treated with intermittent vaginal catheterization and antibiotic prophylaxis, and in one a cystostomy was necessary to temporarily drain the urine. At the age of 6±8 months the patients underwent reconstructive surgery of the UGS via the ASTRA, under a previous protective colostomy.Results The mean (range) age of the patients at the last follow-up was 18.7 (8±32) months. A good cosmetic result was obtained in all patients. The vagina was dilated brie¯y with no anaesthesia in each patient. Patients had normal faecal control after the colostomy was closed and none had urinary incontinence. Conclusions When possible, intermittent vaginal catheterization permits suf®cient temporary drainage of the urinary hydrometrocolpos associated with a persistent UGS. Subsequent ASTRA allows good exposure of the UGS, assuring the preservation of the anorectal innervation and of the sphincteric mechanism.

show abstract

Section: Discussionmentioning

confidence: 99%

The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus

et al. 1999

View full text Add to dashboard Cite

show abstract

“…It is anticipated that surgical reconstruction in infancy will need to be refined at the time of puberty. [54][55][56] Vaginal dilatation should not be undertaken before puberty. The surgeon must be familiar with several operative techniques in order to reconstruct the spectrum of urogenital sinus disorders.…”

Section: Surgical Managementmentioning

confidence: 99%

Consensus Statement on Management of Intersex Disorders

et al. 2006

View full text Add to dashboard Cite

“…A estenose do intróito vaginal é uma complicação tardia freqüentemente relatada na literatura, atingindo até 90% dos casos (7,22,23,25,43). Entretanto, pode ser resolvida com um simples procedimento de abertura do intróito vaginal após a puberdade (44).…”

Section: Discussionunclassified

Genitoplastia feminizante e hiperplasia congênita das adrenais: análise dos resultados anatômicos

Miranda

Filho

Lemos-Marini

et al. 2005

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

RESUMOObjetivo: Avaliar os resultados anatômicos e cosméticos das genitoplastias feminizantes realizadas em meninas com genitália ambígua devido à Hiperplasia Congênita das Adrenais (HCA). Casuística e Métodos: Vinte e sete meninas com HCA e ambigüidade genital (Prader III-V) foram submetidas a genitoplastia feminizante em um estágio e acompanhadas por período médio de quatro anos. Em doze meninas, dois retalhos labioescrotais em ilha foram associados à genitoplastia convencional para adequar os grandes lábios e ampliar o intróito vaginal. Episódios de infecção urinária foram observados em dezesseis meninas no pré-operatório e em apenas sete no pós-operatório. Os resultados cosméticos foram avaliados por meio de sistematização da avaliação anatômica das diferentes estruturas. Resultados: Os da clitoroplastia foram considerados bons em 62,9% dos casos; houve atrofia clitoriana em quatro meninas. Excesso de grandes lábios ocorreu em 25%, e persistência do seio-urogenital em 11% (três meninas nas quais não havia sido associado retalho labioescrotal). O retalho labioescrotal em ilha foi considerado de simples confecção e reprodução. Cinco meninas precisaram ser re-operadas. De um modo geral, os resultados cosméticos foram considerados ótimos ou bons em 63% dos casos, satisfatórios em 18,5% e insatisfatórios ou ruins em 18,5%. Conclusões: Os resultados anatômicos e cosméticos foram classificados como bons na maioria dos casos, porém alguns aspectos técnicos devem ser ajustados com a intenção de evitar complicações irreversíveis e re-operações. Objective: To evaluate the anatomical and cosmetic results of feminizing genitoplasty in girls with ambiguous genitalia due to Congenital Adrenal Hyperplasia (CAH). Casuistic and Methods: Twenty-seven females with genital ambiguity (Prader III-V) due to CAH underwent an one-stage feminizing genitoplasty and were followed for a mean time of 4 years. In twelve girls, two cutaneous labioscrotal island-flaps were associated with the conventional genitoplasty, to decrease the excess of labia majora and to enlarge the vaginal introitus. Urinary tract infections were observed in sixteen girls in the preoperative and in only seven in the postoperative period. The cosmetic results were obtained by the systematic anatomical evaluation of the different structures that compose the genitalia. Results: The results of clitoroplasty were considered good in 63% of the cases; however, 4 girls developed clitoral atrophy. An excess of labia majora was present in 25% and persistence of the urogenital sinus occurred in 11% (three children without labioscrotal island flap). The labioscrotal island flap was considered technically feasible and reproducible. Five girls had to be re-operated. The cosmetic results were considered excellent or good in 63% of the cases, satisfactory in 18.5% and unsatisfactory or bad in 18.5%. Conclusions: The anatomical and cosmetic results were good in majority of the cases; however, some technical aspects should be adjusted, to avoid irreversible sequels and re-operation...

show abstract

Vaginal Reconstruction after Initial Construction of the External Genitalia in Girls With Salt-Wasting Adrenal Hyperplasia

Cited by 87 publications

References 14 publications

The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus

The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus

Consensus Statement on Management of Intersex Disorders

Genitoplastia feminizante e hiperplasia congênita das adrenais: análise dos resultados anatômicos

Contact Info

Product

Resources

About