THE ANTERIOR SAGITTAL TRANSANORECTAL APPROACH - A MODIFIED APPROACH TO 1-STAGE CLITORAL VAGINOPLASTY IN SEVERELY MASCULINIZED FEMALE PSEUDOHERMAPHRODITES - PRELIMINARY-RESULTS

Purpose: We present a modified 1-stage clitoral vaginoplasty technique for severely masculinized female pseudohermaphroditism involving an a nterior sagittal transanorectal approach with the patient prone after clitoroplasty according to the Passerini-Glazel procedure. Material an d Methods: An anterior sagittal transanorectal approach with protectiv e colostomy was performed in 2 patients with severely masculinized fem ale pseudohermaphroditism and a normal rectum. The anorectal sphincter ic mechanism was divided only in the anterior midline, and the perinea l body and rectum were opened in the anterior rectal wall, providing e xcellent exposure of the urogenital sinus. The vagina was easily and f ully separated from the urogenital sinus, the site of vaginal attachme nt to the urethra was sutured, and anastomosis was created between the vaginal neo-introitus and vagina. The rectum, perineal body and anter ior sphincteric mechanism were reconstructed. Results: Cosmetic and an atomical results are satisfactory. The vaginal neo-introitus is locate d just below the urethral meatus, the clitoris appears almost normal a nd in the vulvar region a mucous lining is present in the front wall o f the perineum between the clitoris and vagina. Convalescence was unev entful. The patients had normal bowel control after colostomy closure and no urinary incontinence. Conclusions: Our modified technique favor s easy and safe posterior anastomosis between the vaginal neo-introitu s and vagina under direct vision. Furthermore, suturing the vaginal st ump is easier than in the original technique, since the approach to th e vagina is posterior, not transvesical.