Surgical treatment of vestibulovaginal hypospadias in girls

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Abstract

Objective: To suggest a variant of surgical treatment of vestibulovaginal hypospadias in girls.

Materials and methods: A total of 201 girls were diagnosed with vestibular hypospadias, 16 girls with vestibulovaginal hypospadias, and 3 girls with vaginal hypospadias. Five girls with vestibulovaginal hypospadias underwent surgery, namely, isolation of the urethra from the external orifice to the bladder neck and moving it below the clitoris.

Results: The conservative treatment was prescribed to all children with hypospadias. It was effective only for the patients with the vestibular form of hypospadias. All children experienced vulvitis, vaginitis, chronic cystitis and pyelonephritis. Dystopia of the external urethral orifice was a manifestation of the vulvovaginal form of hypospadias. The X-ray examination revealed vesicoureteral reflux in six children and ureterohydronephrosis in two children. The girls with vestibulovaginal hypospadias (11 out of 16) continued to be treated conservatively. Five girls underwent surgical treatment with a good long-term result.

Conclusion: Ineffective long-term therapy of vulvitis, vaginitis, cystitis, chronic pyelonephritis is an indication for surgical treatment of vestibulovaginal hypospadias. The lower wall of the urethra and the anterior wall of the vagina are a single formation in girls. Only the complete separation of the urethra from the vagina leads the operative manipulation to success. The presence of ectopia of the external urethral orifice, its permanent trauma during coitus may be a substrate of urinary tract infection in sexually mature women. Operative treatment serves as the prevention of postcoital complications in the future.

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About the authors

Anatoly E. Soloviev

Ryazan State Medical University named after academician I.P. Pavlov, Ministry of Health of Russia

Author for correspondence.
Email: beerzombie@rambler.ru

Dr. Med. Sci., Professor, Head of the Department of Pediatric Surgery

Russian Federation, Ryazan

Tatiana M. Cherdantseva

Ryazan State Medical University named after academician I.P. Pavlov, Ministry of Health of Russia

Email: beerzombie@rambler.ru

Dr. Med. Sci., Professor, Head of the Department of Histology, Pathological Anatomy and Medical Genetics

Russian Federation, Ryazan

Denis V. Zenushkin

Ryazan State Medical University named after academician I.P. Pavlov, Ministry of Health of Russia

Email: beerzombie@rambler.ru

clinical resident at the Department of Pediatric Surgery

Russian Federation, Ryazan

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2. Figure. Technique of surgery for vestibulo-vaginal hypospadias. A - vertical incision framing the external opening of the urethra in the vaginal vestibule; B - incision of the mucosa of the upper vaginal wall, separation of the mucosa laterally; C - crossing of the connective tissue-muscular layer from the vagina, mobilization of the entire urethra from the external opening to the bladder neck; D - fixation of the external urethra under the clitoris, suturing of the wound in the upper wall of the vagina and vestibule

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