Criteria for noninvasive evaluation of high urethrovaginal fusion in patients with urogenital sinus at puberty

Abstract

Background. The level of urethrovaginal fusion (UVF) is an important criterion in choosing the tactics of surgical vaginoplasty in patients with urogenital sinus (UGS). The frequency of high UVR among all its forms is 5–10 % and considered the most difficult for surgical correction. There are few publications devoted to studies of the level of UVF in patients at puberty.Aim. To find a non-invasive method for diagnosing high UVF in patients at puberty with UGS.Materials and methods. In order to find a non-invasive method for diagnosing high UVF in this group of patients, we conducted a study based on a comparative assessment of endoscopic findings and data of magnetic resonance imaging (MRI). The study included 36 patients with UGS aged 12 to 34 years (average age 17 ± 5 years) who underwent surgical treatment at the National Medical Research Center of Endocrinology of the Ministry of Health of Russia from 2019 to 2022, including patients with congenital adrenal hyperplasia salt-wasting form (n = 24), viril form (n = 8), partial 46,XY gonadal dysgenesis (n = 2), mixed 45,X0/46,XY gonadal dysgenesis (n = 1), and partial androgen insensitivity syndrome (n = 1). All patients sequentially underwent MRI of the pelvis and endoscopy of the lower urinary tract with a time gap of 1 to 62 days.Results. We confirmed that high UVF in patients with UGS during puberty can be diagnosed in a non-invasive way, by pelvic MRI study. The length of the urethra of 22 mm or less corresponds to a high level of UVF, and the depth of UVF less than 32 mm practically excludes it.Conclusion. The method allows to clarify the severity of UGS in advance, before surgery, to determine the tactics of vaginoplasty and the risk of its complications, and to provide the patient and his relatives with more detailed information to obtain consent for the operation.