Feminizing genital reconstruction: experience with 52 cases of ambiguous genitalia.
OBJECTIVE
The last decade witnessed the introduction of different modifications and even new techniques for feminizing genitoplasty. The claim was that the classical Hendren's procedure was associated with unsatisfactory results. At the King Khalid University Hospital, the Hendren's operation was the procedure of choice for feminizing genitoplasty. In this report, we describe our experience with a total of fifty-two cases of ambiguous genitalia. We understand that this comes in the midst of growing criticism of the Hendren's procedure.


METHODS
The medical records of 52 consecutive patients with ambiguous genitalia who underwent feminizing genital reconstruction were reviewed. Forty-five patients (86.5%) had congenital adrenal hyperplasia (CAH), 3 patients had testicular feminization syndrome, 2 patients had mixed gonadal dysgenesis, one patient had vaginal atresia with Kaufman's syndrome and one patient had isolated congenital clitoromegaly. Age at first presentation ranged between 1 day to 15 years. Feminizing genital reconstruction using Hendren's technique was carried out as a single stage procedure in 29 (55.81%) patients and as staged surgery in 23 (44.2%) patients. A total of 50 clitoral operations and 43 vaginoplasties were performed. Follow-up ranged from 6 months to 12 years (mean 3 and 1/2 years). The surgical results were analyzed and complications documented.


RESULTS
Reconstruction was completed in 47 (90.2%) patients. Thirty-six (78.2%) patients had a satisfactory genital appearance with normal looking clitoris. Seven patients required revision clitoroplasty. Thirty-six (83.7%) patients had a good size vagina appropriate for age. Seven patients (16.2%) had vaginal stenosis and two had revision vaginoplasty with good results. Postoperative complications included urethral fistula (one patient), meatal stenosis (one patient), and transient neurogenic bladder (one patient). The final cosmetic results were considered excellent in 40 (85.1%), fair in 4 patients, and poor in 3 patients.


CONCLUSIONS
The Hendren's techniques of flap vaginoplasty for low confluence and vaginal pull-through for high confluence offer satisfactory cosmetic and functional results. Long-term follow-up is necessary to ensure social and psychosexual adjustment.
Al-Bassam
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Division of Pediatric Surgery, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia. abassam@ksu.edu.sa
Gado
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D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000601:surgery*; D000328:Adult; D013734:Androgen-Insensitivity Syndrome / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002987:Clitoris / Q000601:surgery; D005260:Female; D005836:Genitalia, Female / Q000601:surgery*; D006060:Gonadal Dysgenesis, Mixed / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014621:Vagina / Q000601:surgery