The Perineal Approach for Urogenital Sinus (UGS) Mobilization

Abstract

Purpose We report on the perineal approach for urogenital sinus mobilization. Material and Methods The records of 16 girls undergoing UGS were reviewed. Diagnosis was congenital adrenal hyperplasia (CAH) in 13 girls, and persistent UGS in 3. Mean age at surgery was 5 years (range 1 to 10). Four CAH patients had previous reduction clitoroplasty done. The common UGS was more than 4 cm in 6 girls. Surgery was performed via the perineal approach since all patients had normal anorectal anatomy. A posterior perineal advancement skin flap was used in all patients. Reduction clitoroplasty was done in 10 girls (including 1 redo). In three girls a urethral tube of 4-5 cm was fashioned from the ventral wall of the common UGS to reach an orthotopic position. Postoperative results were assessed by vulvar appearance, location of the urethral meatus and vaginal caliber. Results Mean follow-up was 28 months (range 13 to 46). There were no postoperative complications. All patients have a satisfactory cosmetic appearance. The urethral meatus was situated in an orthotopic position in all patients. All 12 toilet trained children are continent with no stress incontinence. Vaginal calibration was not done in any girl, but an acceptable vaginal opening was easily inspected in all. Conclusions The repair of persistent urogenital; whether low or high confluence type; can be accomplished with urogenital sinus mobilization through the perineal approach. Combined with reduction clitoroplasty the technique is showing short-term successful outcome in girls with CAH. However, more longitudinal follow-up is mandatory.