Management of High Urogenital Sinus in Adults: A Scoping Review

Abstract

Background and Objectives: Persistent urogenital sinus (PUGS) is a rare congenital anomaly resulting from disruptions in urogenital development during embryogenesis. Characterized by the confluence of the vaginal canal and urethra into a single channel, it poses diagnostic and management challenges, particularly in adult patients. Surgical correction remains the primary treatment at an early age, yet there are no universally accepted guidelines regarding treatment at later stages in life. We explored current evidence on the management of high urogenital sinus (HUGS) in adults, focusing on surgical techniques, outcomes, perioperative care, and follow-up. Materials and Methods: A scoping review was conducted using PubMed, Scopus, and Google Scholar, including studies published up to August 2024. Search terms included "high urogenital sinus", "adult patients", and related conditions. Articles were included if they addressed clinical, diagnostic, or therapeutic data on HUGS in adult populations. Data extraction was performed independently by two reviewers, and a PRISMA-ScR flow diagram was used to outline the study selection process. Results: Nine studies met inclusion criteria, with data on surgical techniques, perioperative care, and long-term outcomes extracted for analysis. The included studies highlighted diverse surgical approaches, such as feminizing genitoplasty, buccal mucosa vaginoplasty, posterior prone techniques, and robotic-assisted urogenital sinus mobilization. Complications like vaginal stenosis, urethrovaginal fistula, and urinary incontinence were reported. Long-term outcomes were under-reported, with limited data on sexual function and patient satisfaction. Hormonal therapies, including glucocorticoids, played critical roles in managing cases associated with congenital adrenal hyperplasia (CAH). Conclusions: The management of HUGS requires a multidisciplinary approach integrating advanced surgical techniques and individualized perioperative care. While short-term outcomes are generally favorable, long-term data on sexual function and quality of life remain scarce. Future research should prioritize longitudinal studies to address these gaps, aiming to optimize surgical outcomes, patient satisfaction, and psychosocial well-being.

Keywords: congenital adrenal hyperplasia; feminizing genitoplasty; high urogenital sinus; persistent urogenital sinus; vaginal reconstruction.

Figure 1

PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) flow chart.