Does preoperative genitography in congenital adrenal hyperplasia cases affect surgical approach to feminizing genitoplasty?

Brian A. Vanderbrink, Richard C. Rink, Mark P. Cain, Martin Kaefer, Kirstan K. Meldrum, Rosalia Misseri, Boaz Karmazyn

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: Genitography has traditionally been an imperative part of radiographic evaluation in females born with congenital adrenal hyperplasia before surgical reconstruction. We evaluated the role of preoperative genitogram in surgical reconstruction planning and how it correlates with intraoperative findings. Materials and Methods: We retrospectively reviewed the records of 40 patients with congenital adrenal hyperplasia who underwent feminizing genitoplasty at our institution between 2003 and 2009. Preoperative genitogram findings were recorded and correlated with operative findings. Results: A total of 42 preoperative genitograms were available for review in 40 patients with congenital adrenal hyperplasia who underwent feminizing genitoplasty. Genitography revealed complete anatomy of the urogenital sinus in 30 cases (72%) while bladder filling alone was present in 9 (21%) and vaginal filling was noted in 2 (5%). The urogenital sinus could not be catheterized in 1 patient (2%). Vesicoureteral reflux was identified in 6 patients (15%) with a mean grade of 2. Vaginoplasty was done with a flap technique in 37 patients (more than 90%) while the remaining 3 underwent pull-through vaginoplasty. In no case did genitogram reveal anatomy that was not visible via endoscopy or at reconstruction. The vaginoplasty technique was based on endoscopic and intraoperative findings, and not on genitogram. Conclusions: Genitography during preoperative evaluation in females with congenital adrenal hyperplasia undergoing feminizing genitoplasty did not reveal urogenital sinus anatomy completely in 25% of the patients in our series. Preoperative genitogram did not influence the surgical approach. Its value as preoperative imaging in patients with congenital adrenal hyperplasia may be limited.

Original languageEnglish
Pages (from-to)1793-1797
Number of pages5
JournalJournal of Urology
Volume184
Issue number4 SUPPL.
DOIs
StatePublished - Oct 2010

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Congenital Adrenal Hyperplasia
Anatomy
Vesico-Ureteral Reflux
Endoscopy
Urinary Bladder

Keywords

  • adrenal glands
  • adrenal hyperplasia, congenital
  • diagnostic imaging
  • reconstructive surgical procedures
  • vagina

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Does preoperative genitography in congenital adrenal hyperplasia cases affect surgical approach to feminizing genitoplasty? / Vanderbrink, Brian A.; Rink, Richard C.; Cain, Mark P.; Kaefer, Martin; Meldrum, Kirstan K.; Misseri, Rosalia; Karmazyn, Boaz.

In: Journal of Urology, Vol. 184, No. 4 SUPPL., 10.2010, p. 1793-1797.

Research output: Contribution to journalArticle

Vanderbrink, Brian A. ; Rink, Richard C. ; Cain, Mark P. ; Kaefer, Martin ; Meldrum, Kirstan K. ; Misseri, Rosalia ; Karmazyn, Boaz. / Does preoperative genitography in congenital adrenal hyperplasia cases affect surgical approach to feminizing genitoplasty?. In: Journal of Urology. 2010 ; Vol. 184, No. 4 SUPPL. pp. 1793-1797.
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abstract = "Purpose: Genitography has traditionally been an imperative part of radiographic evaluation in females born with congenital adrenal hyperplasia before surgical reconstruction. We evaluated the role of preoperative genitogram in surgical reconstruction planning and how it correlates with intraoperative findings. Materials and Methods: We retrospectively reviewed the records of 40 patients with congenital adrenal hyperplasia who underwent feminizing genitoplasty at our institution between 2003 and 2009. Preoperative genitogram findings were recorded and correlated with operative findings. Results: A total of 42 preoperative genitograms were available for review in 40 patients with congenital adrenal hyperplasia who underwent feminizing genitoplasty. Genitography revealed complete anatomy of the urogenital sinus in 30 cases (72{\%}) while bladder filling alone was present in 9 (21{\%}) and vaginal filling was noted in 2 (5{\%}). The urogenital sinus could not be catheterized in 1 patient (2{\%}). Vesicoureteral reflux was identified in 6 patients (15{\%}) with a mean grade of 2. Vaginoplasty was done with a flap technique in 37 patients (more than 90{\%}) while the remaining 3 underwent pull-through vaginoplasty. In no case did genitogram reveal anatomy that was not visible via endoscopy or at reconstruction. The vaginoplasty technique was based on endoscopic and intraoperative findings, and not on genitogram. Conclusions: Genitography during preoperative evaluation in females with congenital adrenal hyperplasia undergoing feminizing genitoplasty did not reveal urogenital sinus anatomy completely in 25{\%} of the patients in our series. Preoperative genitogram did not influence the surgical approach. Its value as preoperative imaging in patients with congenital adrenal hyperplasia may be limited.",
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N2 - Purpose: Genitography has traditionally been an imperative part of radiographic evaluation in females born with congenital adrenal hyperplasia before surgical reconstruction. We evaluated the role of preoperative genitogram in surgical reconstruction planning and how it correlates with intraoperative findings. Materials and Methods: We retrospectively reviewed the records of 40 patients with congenital adrenal hyperplasia who underwent feminizing genitoplasty at our institution between 2003 and 2009. Preoperative genitogram findings were recorded and correlated with operative findings. Results: A total of 42 preoperative genitograms were available for review in 40 patients with congenital adrenal hyperplasia who underwent feminizing genitoplasty. Genitography revealed complete anatomy of the urogenital sinus in 30 cases (72%) while bladder filling alone was present in 9 (21%) and vaginal filling was noted in 2 (5%). The urogenital sinus could not be catheterized in 1 patient (2%). Vesicoureteral reflux was identified in 6 patients (15%) with a mean grade of 2. Vaginoplasty was done with a flap technique in 37 patients (more than 90%) while the remaining 3 underwent pull-through vaginoplasty. In no case did genitogram reveal anatomy that was not visible via endoscopy or at reconstruction. The vaginoplasty technique was based on endoscopic and intraoperative findings, and not on genitogram. Conclusions: Genitography during preoperative evaluation in females with congenital adrenal hyperplasia undergoing feminizing genitoplasty did not reveal urogenital sinus anatomy completely in 25% of the patients in our series. Preoperative genitogram did not influence the surgical approach. Its value as preoperative imaging in patients with congenital adrenal hyperplasia may be limited.

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