Transabdominal pelvic sonography in the preoperative evaluation of patients with congenital adrenal hyperplasia

Purpose. We assessed the clinical value of transabdominal pelvic sonography in the preoperative evaluation of patients with congenital adrenal hyperpl asia (CAH) who required feminizing genitoplasty. Methods. From 1987 to 1998, 31 patients with female pseudohermaphroditism d ue to CAH underwent feminizing genitoplasty. The median age of the patients was 9 months (range, 1-18 years). Radiologic evaluation performed before s urgical reconstruction included retrograde genitography in the first 10 pat ients and sonographic examination in all 31 patients. Imaging was used to e valuate the anatomic positions and the length of the vagina, whether the ju nction of the vagina and the urogenital sinus occurred distal or proximal t o the pelvic floor, and the presence of internal genitalia. Results. Abdominal sonography identified internal female genitalia in all 3 1 patients, identified the anatomic shape and position of the vagina in 30 patients (97%), and confirmed the site of communication between the vagina and the urogenital sinus relative to the pelvic floor in 28 patients (90%). Sonographic findings were confirmed by intraoperative panendoscopy. Genito graphy was less useful than sonography, identifying the site of communicati on between the vagina and urogenital sinus in only 6 (60%) of 10 patients. Conclusions. In patients with CAH undergoing vaginal reconstruction, sonogr aphy provides adequate information about the anatomy of the vagina and urog enital sinus for surgical decisionmaking. (C) 2000 John Wiley & Sons, Inc.