A feminization plastic surgical procedure for a high urethrovaginal confluence and a long genitourinary common channel in puberty girls with a disorder of sexual development


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Resumo

Objective: To improve the results of feminization plastic surgeries in girls with a disorder of sexual development. Materials and methods: A procedure was proposed for dissociative feminization plastic surgery, which was used in 2018 to 2019 to operate on four girls in the chronological and clinico-hormonal therapy-induced puberty period with virilization of the external genitalia, a high urethrovaginal confluence (UVC), and a long genitourinary common channel (GUCC). Results: Based on the partial urogenital mobilization described by R.C. Rink in 2006, the authors developed a new procedure of feminization plastic surgery for puberty patients with a high UVC and a long GUCC. The procedure is characterized by the preparation of a mucosal flap of the GUCC, by laying it in a W-shaped way to create the anterior and lateral walls of the artificial vaginal orifice (AVO) and preparing the posterior wall of the vagina to create the posterior wall of the AVO. The calculation of the minimum GUCC length, which is required for successful surgery, is presented. Good results were obtained in all the patients. Conclusion: The proposed procedure makes it possible to form the female external genitalia with the separately opening urethra and vagina, with the moist mucous orifice, with the possibility of adequate sexual life in the future, without the risk of vaginal stenosis and urinary disorders.

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Sobre autores

Alexander Anikiev

National Medical Research Center for Endocrinology Ministry оf Health оf Russia

Email: anikieal70@gmail.com
PhD, surgeon of Pediatric Surgeon Department 117036, Russia, Moscow, Dm. Ulyanova str., 11

Dmitriy Brovin

National Medical Research Center for Endocrinology Ministry оf Health оf Russia

Email: brovin-dn@yandexru
PhD, Head of Pediatric Surgeon Department 117036, Russia, Moscow, Dm. Ulyanova str., 11

Elena Volodko

Russian Medical Academy of Continuing Professional Education Ministry of Health of Russia

Email: okulov20@yandex.ru
Dr. Med. Sci., Professor of Pediatric Surgery Department 125993, Russia, Moscow, Barrikadnaya str., 2/1 b.1

Alexey Okulov

Russian Medical Academy of Continuing Professional Education Ministry of Health of Russia

Email: okulov20@yandex.ru
Dr. Med. Sci., Professor of Pediatric Surgery Department 125993, Russia, Moscow, Barrikadnaya str., 2/1 b.1

Elena Andreeva

National Medical Research Center for Endocrinology Ministry of Health of Russia

Email: endogin@mail.ru
Dr. Med. Sci., Professor, Director of Reproductive Medicine Institution, Head of Endocrine Gynecology Department, Professor of Department of Endocrinology 117036, Russia, Moscow, Dm. Ulyanova str., 11

Bibliografia

  1. Prader A. Die Haufigkeit des kongenitalen androgenitalen Syndroms. Helv. Pediatr. Acta. 1958; 13: 426-31.
  2. Marei M.M., Fares A.E., Abdelsattar A.H., Abdullateef K.S., Seif H., Hassan M.M. et al. Anatomical measurements of the urogenital sinus in virilized female children due to congenital adrenal hyperplasia. J. Pediatr. Urol. 2016; 12(5): 282. e1-282. e8. https://dx.doi.org/10.1016/j.jpurol.2016.02.008.
  3. Sircili M.H.P., Bachega T.S.S., Madureira G., Gomes L., Mendonca B.B., Denes F.T. Surgical treatment after failed primary correction of urogenital sinus in female patients with virilizing congenital adrenal hyperplasia: Are good results possible? Front. Pediatr. 2016; 4: 118. https://dx.doi.org/10.3389/fped.2016.00118.
  4. Podesta M., Urcullo J. Perineal mobilization of the common urogenital sinus for surgical correction of high urethrovaginal confluence in patients with intersex disorders. J. Pediatr. Urol. 2008; 4(5): 352-8. https://dx.doi.org/10.1016/j.jpurol.2008.02.009.
  5. Фомина М.А., Бижанова Д.А., Арзамасцева Л.В., Протасов А.А., Карманов М.Е., Дядик Т.Г. Оценка результатов феминизирующей пластики у девочек-подростков с врожденной дисфункцией коры надпочечников в отдаленном послеоперационном периоде. Детская больница. 2010; 2: 35-9.
  6. Лопаткин Н.А., ред. Руководство по урологии. Т. 2. М.: Медицина; 1998: 368.
  7. Rink R.C., Metcalfe P.D., Kaefer M.A., Casale A.J., Meldrum K.K., Cain M.P Partial urogenital mobilization: a limited proximal dissection. J. Pediatr. Urol. 2006; 2(4): 351-6. https://dx.doi.org/10.1016/j.jpurol.2006.04.002.
  8. Комяков Б.К., Родыгин Л.М. Результаты хирургического лечения гипермобильности и эктопии уретры у женщин с хроническим циститом. В кн.: Материалы IV городской научно-практической конференции «Актуальные вопросы урологии и гинекологии». Санкт-Петербург, 4 декабря 2009 г. СПб.; 2009: 49-51.
  9. Nidal S., Kocherov S., Jaber J., Levi-Kedmi F., Farkas A., Chertin B. Sexual function and voiding status following one stage feminizing genitoplasty. J. Pediatr. Urol. 2020; 16(1): 97.e1-97.e6. https://dx.doi.org/10.1016/j.jpurol.2019.11.017.
  10. Pena A. Total urogenital mobilization - an easier way to repair cloacas. Eur. J. Pediatr. Surg. 1997; 32(2): 263-7; discussion 267-8. https://dx.doi.org/10.1016/s0022-3468(97)90191-3.
  11. Domini R., Rossi F., Ceccarelli P.L., De Castro R. Anterior sagittal transanorectal approach to the urogenital sinus in adrenogenital syndrome: preliminary report. J. Pediatr. Surg. 1997; 32(5): 714-6. https://dx.doi.org/10.1016/s0022-3468(97)90012-9.
  12. Salle J.L., Lorenzo A.J., Jesus L.E., Leslie B., AlSaid A., Mace do FN. et al. Surgical treatment of high urogenital sinuses using the anterior sagittal transrectal approach: a useful strategy to optimize exposure and outcomes. J. Urol. 2012; 187(3): 1024-31. https://dx.doi.org/10.1016/j.juro.2011.10.162.
  13. Каганцов И.М., Ширяев Н.Д., de Castro R. Хирургическая коррекция высокого урогенитального синуса у девочек с врожденной гиперплазией надпочечников передним сагиттальным трансаноректальным доступом. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2018; 8(1): 13-22

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