Total urogenital mobilization by CAH: a step-by-step illustration of the technique.
BACKGROUND
Congenital adrenal hyperplasia (CAH) resulting from deficient 21-hydroxylase activity is an autosomal recessive disorder with an incidence of 1:5000-25,000 in Caucasian populations. Despite various techniques to treat CAH, total urogenital mobilization (TUM) has gained popularity. This technique has low morbidity, and can be performed by the perineal route with the patient in the dorsal lithotomy position without the need to separate the urethra from the vagina. We aim to demonstrate in this video the TUM technique step by step.


METHODS
A 9-month-old child, born with ambiguous genitalia (Prader 3) with a 46XX karyotype and CAH diagnosis presented to our facility. Endoscopy showed a 2-cm common channel.


CONCLUSIONS
The patient was treated as described in the video and she had an uneventful clinical outcome with complete healing. TUM is an excellent alternative for treating CAH.
Federal University of São Paulo, São Paulo, Brazil.
Antonio
A
Macedo
Federal University of São Paulo, São Paulo, Brazil. Electronic address: ma_celaleal@yahoo.com.br.
Marcela
M
Leal da Cruz
Federal University of São Paulo, São Paulo, Brazil.
Riberto
R
Liguori
Federal University of São Paulo, São Paulo, Brazil.
Rodrigo
R
Trivelato
Federal University of São Paulo, São Paulo, Brazil.
Sérgio Leite
SL
Ottoni
Federal University of São Paulo, São Paulo, Brazil.
Diego Estevam Gomes
DE
Oliveira
Federal University of São Paulo, São Paulo, Brazil.
Geórgia Rubiane
GR
Souza
Federal University of São Paulo, São Paulo, Brazil.
Valdemar
V
Ortiz
D058489:46, XX Disorders of Sex Development / Q000150:complications / Q000601:surgery*; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D013519:Urogenital Surgical Procedures / Q000379:methods*
Congenital adrenal hyperplasia; Genitalia; Pediatric