ESPE Abstracts (2014) 82 P-D-2-1-569

Experience of Feminizing Operations in Cases of Incomplete Sexual Development of Girls

Alena Shybeka, Hanna Milkhno, Herman Druzhynin, Vitali Dubrov, Anzhalika Solntsava & Izaokas Skobejus

2nd City Children’s clinical Hospital, Minsk, Belarus

Background: Surgical correction of the external genitalia of girls with incomplete sexual development remains an urgent problem reconstructive urology. It is connected with a relative rare pathology, the need to achieve a good cosmetic and functional result.

Objective and hypotheses: In this paper, we present our approach and experience in the surgical treatment of girls born with congenital malformations of sexual organs.

Method: Between 2005 and 2013, we operated on 41 patients (4.8±0.5 years). Diagnoses included 33 cases of congenital adrenal hyperplasia; six cases of gonadal dysgenesis; one true hermaphroditism; one anogenital cleft. We determined the genetic, gonadal, phenotypic, and hormonal status of these patients. Treatment was carried out in conjunction with a pediatric endocrinologist and, if necessary, hormonal therapy. To determine the level of interconnection of urinary and reproductive tract, cystoscopy was performed before each operation. When connecting the urinary and genital tract above the urogenital diaphragm (high urogenital sinus) only clitoroplasty was performed (29 patients, 5.5±0.8 years), with a low urogenital sinus – single-step clitorovaginoplasty (12 patients, 3.3±0.4 years).

Results: The observation of patients ranged from 1 to 8 years. All the girls are satisfied with the result of the external genitalia. But children who underwent only clitoroplasty be the second phase of the operation to form the entrance to the vagina. Among patients who underwent one-stage clitorovaginoplasty positive result was achieved in ten cases (83.3%). In two cases (16.7%) diagnosed with stenosis of the vagina. In 2012 two patients postoperatively used Estriol (in candlelight or ointments) within a week after surgery. These patients were observed for a year, during which a narrowing of the vestibule was not observed.

Conclusion: Differentiated approach to feminizing operations in young children, depending on the level of merger urethra and vagina what improves the cosmetic result, and facilitates a normal mental status and early social adaptation.

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