ESPE Abstracts

Introduction: In virilized females with Congenital Adrenal Hyperplasia (CAH), the principal aims of surgery are to reduce the size of clitoris, create a vaginal orifice that will allow menstrual flow and intercourse, and to correct the urogenital sinus to prevent incontinence.

Surgical techniques evolved with time to make not only "cosmetically accepted" genitalia but also normally functioning. The complications of feminizing genitoplasty include urinary complications as regards the voiding function and continence.

Symptoms of voiding dysfunction include dysuria, urgency, and frequency. The dysfunctional voiding scoring system may help to identify patients with postoperative urinary complications.

Aim of the work: To assess the function of lower urinary tract following Feminizing Genitoplasty in females with CAH.

Subjects and Methods: This study included 40 female children with CAH aged more than 3 years attending the endocrinology clinic in Alexandria University Children's Hospital, Egypt. Thorough history taking and clinical examination were done with emphasis on age at diagnosis and duration of disease, timing and stages of surgery, and presence of urinary symptoms. Assessment of lower urinary tract function using dysfunctional voiding score system was done for them at least 6 months after the surgery. Urodynamic evaluation was performed for females with score more than 6.

Results: The mean age of the cases was 8.2 years with mean duration of CAH of 7.9 years. 67.5% were controlled on medical treatment and 80% had done surgical correction in one stage operation. By applying the dysfunctional voiding score system, 72.5% of cases had score ≤ 6 and there were 11 cases (27.5) had score > 6. It was found that 7 cases (out of 11 with high score) had Bell shaped curve on Urodynamic study. There were 3 cases with Interrupted curve and only one case with Plateau curve. There were 9 patients improved after toilet training.

Conclusion: Lower urinary tract symptoms are common in females children with CAH after Feminizing Genitoplasty so early assessment is needed to prevent urinary complications.