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NEW CONCEPTS IN FEMINIZING GENITOPLASTY—IS THE FORTUNOFF FLAP OBSOLETE?

2005; Lippincott Williams & Wilkins; Volume: 174; Issue: 6 Linguagem: Inglês

10.1097/01.ju.0000180419.62193.78

1527-3792

Rafael Gosálbez, Miguel Castellán, Emad Ibrahim, Michael DiSandro, Andrew Labbie,

Genital Health and Disease

No AccessJournal of UrologyPediatric Urology1 Dec 2005NEW CONCEPTS IN FEMINIZING GENITOPLASTY—IS THE FORTUNOFF FLAP OBSOLETE? RAFAEL GOSALBEZ, MIGUEL CASTELLAN, EMAD IBRAHIM, MICHAEL DiSANDRO, and ANDREW LABBIE RAFAEL GOSALBEZRAFAEL GOSALBEZ , MIGUEL CASTELLANMIGUEL CASTELLAN , EMAD IBRAHIMEMAD IBRAHIM , MICHAEL DiSANDROMICHAEL DiSANDRO , and ANDREW LABBIEANDREW LABBIE View All Author Informationhttps://doi.org/10.1097/01.ju.0000180419.62193.78AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We retrospectively evaluated the results of an original technique that combines mobilization of the urogenital sinus with the creation of urogenital flaps to enlarge the vaginal introitus for 1-stage feminizing genitoplasty in children with urogenital sinus anomalies, thus, avoiding the use of posteriorly based perineal flaps. Materials and Methods: A total of 11 patients with urogenital sinus anomalies have undergone a modified Fortunoff technique combining total urogenital mobilization with the creation of urogenital sinus flaps by a single surgeon (RG) since 1998. Patient age at surgery ranged from 3 months to 13 years (mean 3.8 years). Diagnoses included congenital adrenal hyperplasia in 7 patients, cloacal malformation in 2 and urogenital sinus malformation in 2. Eight patients underwent a perineal approach and 3 underwent a posterior sagittal approach. Results: Followup ranged from 3 months to 5 years (mean 2.5 years). The cosmetic appearance was considered superior to that achieved with previous techniques. The vagina had a more physiological position in all patients except 1, and no patient had development of vaginal stenosis. One patient had development of a mild mid urethral stricture that required a single dilation using anesthesia. In this patient cystourethroscopy performed 3 years later was normal. Conclusions: We believe that the redundant urogenital sinus tissue must not be discarded, but rather incorporated into the reconstruction of the posterior vaginal wall, thus, avoiding the use of perineal skin flaps. This modification allows placement of the vaginal opening in a more physiological position with a better cosmetic appearance than previous techniques. References 1 : Vaginoplasty technique for female pseudohermaphrodites. Surg Gynecol Obstet1964; 118: 545. Google Scholar 2 : Single stage feminization genitoplasty. J Urol1989; 143: 776. Google Scholar 3 : Reconstruction of the high urogenital sinus: early perineal prone approach without division of the rectum. J Urol1997; 158: 1293. Link, Google Scholar 4 : Total urogenital sinus mobilization: a modified perineal approach for feminizing genitoplasty and urogenital sinus repair. J Urol2001; 165: 2347. Link, Google Scholar 5 : Surgical management of female genital anomalies, intersex (urogenital sinus) disorders, and cloacal anomalies. In: Pediatric Urology. Edited by . Philadelphia: W. B. Saunders Co.2001: 659. part VI. Google Scholar 6 : The gynecological aspects of adrenal hyperplasia and allied disorders. Am J Obstet Gynecol1954; 68: 1330. Google Scholar 7 : Correction of congenital abnormalities of the vagina and perineum. J Pediatr Surg1980; 15: 751. Google Scholar 8 : Total urogenital mobilization—an easier way to repair cloacas. J Pediatr Surg1997; 32: 263. Google Scholar 9 : Total urogenital sinus mobilization: expanded applications. BJU Int1999; 83: 820. Google Scholar 10 Rink R.C., Casale A.J., Cain M.P. Total urogenital mobilization: use of the mobilized sinus. Presented at American Academy of Pediatrics, Boston, Massachusetts, abstract 2, 2002 Google Scholar 11 : A new 1-stage procedure for clitorovaginoplasty in severely masculinized female pseudohermaphrodites. J Urol1989; 142: 565. Link, Google Scholar 12 : Congenital adrenal hyperplasia and lower urinary tract symptoms. BJU Int2005; 95: 1263. Google Scholar 13 : Total urogenital sinus mobilization in the repair of cloacal anomalies and congenital adrenal hyperplasia. J Pediatr Surg2001; 36: 1656. Google Scholar From the Division of Pediatric Urology, Miami Children's Hospital and Jackson Memorial Hospital, and Department of Urology, University of Miami, Miami, Florida© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByPalmer B, Trojan B, Griffin K, Reiner W, Wisniewski A, Frimberger D and Kropp B (2018) Total and Partial Urogenital Mobilization: Focus on Urinary ContinenceJournal of Urology, VOL. 187, NO. 4, (1422-1426), Online publication date: 1-Apr-2012.Camanni D, Zaccara A, Capitanucci M, Mosiello G, Iacobelli B and De Gennaro M (2009) Bladder After Total Urogenital Mobilization for Congenital Adrenal Hyperplasia and Cloaca—Does it Behave the Same?Journal of Urology, VOL. 182, NO. 4S, (1892-1897), Online publication date: 1-Oct-2009.Leclair M, Gundetti M, Kiely E and Wilcox D (2018) The Surgical Outcome of Total Urogenital Mobilization for Cloacal RepairJournal of Urology, VOL. 177, NO. 4, (1492-1495), Online publication date: 1-Apr-2007. Volume 174Issue 6December 2005Page: 2350-2353 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsurologic surgical proceduresgenitalia, femalevaginaadrenal hyperplasia, congenitalsurgical flapsMetricsAuthor Information RAFAEL GOSALBEZ More articles by this author MIGUEL CASTELLAN More articles by this author EMAD IBRAHIM More articles by this author MICHAEL DiSANDRO More articles by this author ANDREW LABBIE More articles by this author Expand All Advertisement PDF DownloadLoading ...