Vaginoplasty using the inner surface or mucosa of the prepuce in children with congenital adrenal hyperplasia

Abstract

Objective: To describe and present the results of the use of the inner surface or mucosa of the prepuce in vaginoplasty for ambiguous genitalia.

Patients and methods: This technique can be used alone in low vaginal insertion or associated with a total urogenital mobilization in cases of high vagina. During the past 7 years, we have performed 18 vaginoplasties using the described technique in 46, XX DSD (female pseudohermaphroditism). All patients had 21-hydroxylase deficiency; four had the simple virilizing form and 14 had additional salt loss. The age of the patients at surgery varied from 4 to 28 months (average 11.2).

Results: The final cosmetic results were considered good by the parents and surgeon for the majority of our patients, and satisfactory in three cases. Clinical examination revealed stenosis of vaginal introitus in only one patient (which responded very well to one dilatation) and one urethra-vaginal fistula.

Conclusion: This technique of vaginoplasty, simple in its realization and answering the purpose of treatment with few complications, can be used in the feminizing genitoplasty of young children with 46,XX DSD, ovotesticular DSD (true hermaphroditism), mixed gonadal dysgenesis and dysgenetic male pseudohermaphroditism.

Keywords: Ambiguous genitalia; DSD 46XX; Female pseudohermaphroditism; Feminizing genitoplasty; Vaginoplasty.