title: Anatomical and functional outcomes of feminizing genitoplasty for ambiguous genitalia in patients with virilizing congenital adrenal hyperplasia.
abstract: The ideal surgical technique and appropriate age for performing feminizing genitoplasty are debatable, and few long-term outcome studies have been reported.
  
  
  OBJECTIVE
  To report a retrospective study on anatomical and functional outcomes of feminizing genitoplasty in patients with virilizing congenital adrenal hyperplasia.
  
  
  METHODS
  We selected 34 patients (mean age = 3.4 +/- 2.5 yr) with genital ambiguity classified according to Prader stage. Follow-up ranged from 2 to 16 years. Clitoral length ranged from 1.9 to 5.0 cm; 28 patients had a single perineal orifice, and 6 had a double orifice. The surgical technique included clitorovaginoplasty in a single procedure and was carried out before 2 years of age in 18 patients. Clitoroplasty was performed with glans preservation in all patients. Blood supply was exclusively maintained by the frenular pedicle in 97% of the cases, whereas clitoral dorsal nerves and vessels were preserved in the remaining 3%. The opening of the urogenital sinus was performed using either the Y-V perineal flap procedure (25 patients) or the cut-back incision procedure (8 patients).
  
  
  RESULTS
  Good morphological and functional results were achieved in 68% of the patients; 21% of the patients had surgical complications, such as incision bleeding (2 cases), glans necrosis (1 girl with Prader V), and vaginal introitus stenosis (4 cases). Three of the latter underwent dilation with acrylic molds in the post-pubertal period with good functional results.
  
  
  CONCLUSIONS
  We conclude that single-stage feminizing genitoplasty consisting of vulvoplasty, clitoroplasty, and Y-V perineal flap produced good cosmetic and functional results in virilized girls with congenital adrenal hyperplasia, with few complications. In addition, this surgical approach prevented the need for neovaginaplasty even in patients with high vaginal insertion.
authors.affiliation: Endocrinology Unit, Hospital das Clínicas, São Paulo University Medical School, Brazil. mhps_msm@yahoo.com
authors.forename: Maria Helena Palma
authors.initials: MH
authors.lastname: Sircili
authors.forename: Berenice B
authors.initials: BB
authors.lastname: de Mendonca
authors.forename: Francisco Tibor
authors.initials: FT
authors.lastname: Denes
authors.forename: Guiomar
authors.initials: G
authors.lastname: Madureira
authors.forename: Tânia Aparecida Sartori Sanchez
authors.initials: TA
authors.lastname: Bachega
authors.forename: Frederico Arnaldo de Queiroz
authors.initials: FA
authors.lastname: e Silva
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*; D014770:Virilism / Q000601:surgery*