NEW CLASSIFICATION OF HYPOSPADIAS IN GIRLS ACCORDING TO MODERN CONCEPTS OF DISORDERS OF SEXUAL DEVELOPMENT AND SURGICAL MANAGEMENT STRATEGY

Objective: To optimize the classification of hypospadias in girls based on a review of the literature and experience with this pathology. Materials and methods: The study included follow-up data from 114 female hypospadias patients aged from 6 months to 42 years. All patients were diagnosed with different variants of disorders of sexual development (DSD) including salt-wasting congenital adrenal hyperplasia (CAH) (n=79), virile form of CAH (n=17), idiopathic virilization (n=3), mixed dysgenesis of gonads (n=2), partial dysgenesis of gonads (n=3), and hypospadias due to urethral malformation (n=10). All patients with urogenital sinus underwent surgery. Urethral transposition was performed in three patients with vestibular and vestibulovaginal forms of hypospadias complicated by recurrent urinary tract infection. Two girls with total hypospadias underwent surgery for upper urinary tract malformations and urinary incontinence. Results: Based on the observations presented, we proposed a new classification of hypospadias in girls: 1. Hypospadias due to urethral malformations a) Vestibular; b) Vestibulovaginal; c) Total. 2. Hypospadias due to virilization of the external genitalia a) Urogenital sinus 1) Mild form; 2) Medium form; 3) Severe form. b) Low-vaginal ectopia of the external urethral opening c) High-vaginal ectopia of the external urethral opening. Conclusion: The new classification will help to determine the rational surgical management strategy for hypospadias in girls and facilitate the interaction of physicians of different specialties.

hypospadias in girls, urogenital sinus, introitoplasty with urinary and genital tract separation, urethral transposition