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Published on: August 14, 2019
Total urogenital sinus mobilization: expanded applications
B Ludwikowski1, I Oesch Hayward, R González
1Department of Paediatric Surgery, Landeskrankenanstalten, Salzburg, Austria.
Insights
Total urogenital sinus mobilization simplifies surgical correction for various urogenital malformations, including persistent cloaca and congenital adrenal hyperplasia (CAH), preserving urinary continence in most cases.
Area of Science:
- Pediatric Surgery
- Urology
- Genitourinary Reconstruction
Background:
- Congenital urogenital malformations, such as persistent cloaca and urogenital sinus (UGS) anomalies, present complex surgical challenges.
- Previous methods for correcting these conditions can be intricate, necessitating simpler and more effective techniques.
Purpose of the Study:
- To evaluate the extended applications of total urogenital sinus mobilization as a simplified surgical approach.
- To assess the efficacy and outcomes of this technique in a cohort of pediatric patients with diverse UGS malformations.
Main Methods:
- A cohort of seven children (six girls, one boy) with diagnoses including persistent cloaca, congenital adrenal hyperplasia (CAH), UGS, bladder exstrophy, and penile agenesis underwent surgery.
- The total urogenital sinus mobilization technique involved a posterior sagittal incision, circumferential dissection, and creation of separate vaginal and urethral openings for UGS ≤3 cm.
Main Results:
- All patients achieved separate vaginal and urethral openings.
- Urinary continence was preserved in three patients; one patient with bladder exstrophy remained incontinent.
- Outcomes in younger patients are pending toilet training assessment.
Conclusions:
- Total urogenital sinus mobilization offers a simplified and effective surgical correction for UGS malformations.
- The technique is confirmed as useful for persistent cloaca and beneficial for patients with CAH, primary UGS, and selected cases of bladder exstrophy and penile agenesis.
- Urinary continence is maintained despite extensive mobilization, indicating the technique's safety and efficacy.
Objective:
To report further applications of total urogenital sinus mobilization, earlier described as an easier method to correct a cloaca.
Patients And Methods:
Seven children (six girls and one boy, mean age 4 years, range 3 months to 10.5 years) underwent surgery and were followed for a mean of 1 year; their diagnoses included persistent cloaca and congenital adrenal hyperplasia (CAH) in two each, and a urogenital sinus (UGS), bladder exstrophy and penile agenesis in one each. The UGS is approached through a posterior sagittal incision and dissected circumferentially to the retropubic space, allowing the UGS to descend. It is then excised and separate openings of the vagina and urethra created. This technique is applicable to a UGS of
Results:
In all patients, separate openings for the urethra and vagina were created. In three patients urinary continence was preserved after surgery. The patient with bladder exstrophy remains incontinent. The remaining patients are too young to assess (not yet toilet-trained).
Conclusion:
This technique simplifies the surgical correction of UGS malformation; we confirm its usefulness in cases of persistent cloaca. It is also valuable in patients with CAH, primary UGS and in selected patients with bladder exstrophy and penile agenesis. When the UGS is not associated with a cloaca, the procedure can be performed perineally. Despite circumferential mobilization of the UGS, urinary continence is preserved.
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