1-stage feminizing genitoplasty: 8 years of experience with 49 cases

Purpose: We retrospectively evaluated the results of a modified technique f or 1-stage feminizing genitoplasty in children with congenital adrenal hype rplasia (CAH) and other rare intersex conditions. Materials and Methods: Between 1991 and 1998, 47 infants and 2 adolescents underwent 1-stage feminizing genitoplasty at our hospital. Of the patients 44 had CAH, 2 had the partial androgen insensitivity syndrome and 3 were tr ue hermaphrodites. In 3 patients we used the Passerini-Glazel technique, wh ile in 46 our technique of feminizing genitoplasty was used, which consists of maximal mobilization of the urogenital sinus en bloc including the vagi na and urethra via the perineal approach. Two lateral plates built from dor sal split phallic and preputial skin together with the dorsal split urogeni tal sinus are used to construct the vaginal introitus and labia minora, and the scrotal folds are used to construct the labia majora. Reduction clitor oplasty is done according to the technique of Kogan et al. Mean age plus or minus standard deviation was 0.9 +/- 0.3 years of the patients with CAH an d 13 +/- 2.3 of the remainder. Preoperative information, including status o f the internal genitalia, anatomical length of the vagina site of communica tion between the vagina and urogenital sinus, in relation to the pelvic flo or, was obtained by transabdominal pelvic ultrasound. Results: Operating time ranged between 120 and 180 minutes, average hospita lization period was 4 to 5 days and mean followup was 4.7 +/- 2.6 years. Pr eoperative ultrasound provided the correct data regarding the vaginal and i nternal genitalia anatomy in all cases, and the exact communication site be tween the vagina and urogenital sinus was demonstrated in 93%. Complication s consisted of intraoperative rectal injury in 1 case and mild wound infect ion of the buttocks area in 3. In 1 case total clitoris loss was observed. All patients who underwent modified genitoplasty have had successful cosmet ic and early functional results. Two patients presented with repeat clitoro megalia due to inadequate adrenal suppression. Conclusions: Our adapted technique of 1-stage feminizing genitoplasty provi des good cosmetic and functional results. The functional results of this op eration should be reevaluated after puberty and in adulthood.