Total urogenital sinus mobilization in the repair of cloacal anomalies and congenital adrenal hyperplasia

Abstract

Purpose: Urogenital sinus mobilization has facilitated markedly the vaginal reconstruction in cases of cloacal anomalies. Application of the same technique in cases of congenital adrenal hyperplasia has resulted in cosmetic and functional improvement. Methods: Total urogenital sinus mobilization was used as a part of the repair in 9 patients: 6 with congenital adrenal hyperplasia (4 high and 2 mid vaginal confluence), and 3 with cloacal anomalies; sinus mobilization to the level of the symphesis pubis allowed the vagina to reach the perineum in all cases. Their age ranged from 6 to 8 months, and follow-up ranged from 6 months to 2 years. In the former group, the mobilized sinus was split dorsally and used as an anterior vaginal flap. Cases of cloaca needed weekly dilatation early postoperatively. Results: All patients are below 3 years of age, so urinary control assessment is not yet objective; however, all mothers reported dry intervals. Examination 6 months postoperatively showed wide vagina and excellent cosmetic appearance in all cases. Conclusions: Total urogenital mobilization provides an easier way for vaginal reconstruction. The improved cosmetic appearance and the absence of vaginal stenosis provided by this technique is a major advantage in the management of these difficult surgical situations. J Pediatr Surg 36:1656-1658. Copyright © 2001 by W.B. Saunders Company.