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.