Pankaj P Dangle1, Andy Lee2, Rajeev Chaudhry3, Francis X Schneck3. 1. Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: pankajdangle@gmail.com. 2. School of Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA. 3. Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
Abstract
OBJECTIVE: To review the intermediate- to long-term surgical complications following feminizing reconstructive surgery for patients with congenital adrenal hyperplasia (CAH) at a single tertiary center. Genitourinary reconstructive surgery is pivotal to favorable cosmetic and functional outcomes for patients with CAH. MATERIALS AND METHODS: We conducted a retrospective review identifying 26 patients from April 2003 to April 2015 who underwent genitourinary reconstructive surgeries. Demographic data and surgical postoperative complications (per Unplanned Postoperative Morbidity in Children [UPMC] and Clavien-Dindo classification) were evaluated. RESULTS: The average age at the time primary surgery was done at our institute was 17 ± 20 (5-87) months; the average length of follow-up was 72.56 ± 36.95 (4.5-142) months. The average length of the common urogenital sinus was 4.5 ± 1.9 (2.5-6.4) cm, and 15 out of 22 (68%) patients had high confluence. A total of 7 complications were observed in 7 (27%) patients, 3 patients had Clavien grade I and UPMC 0 (dysuria, stitch dehiscence, wound separation), and 2 had Clavien grade II and UPMC 1 (urinary tract infection). Two (7.6%) patients required revision surgery, and both of them had Clavien grade IIIB. One patient had UPMC score 5 (suprapubic tube insertion for urinary retention secondary to cicatrization of the surgical site). CONCLUSION: Genitourinary reconstructive surgery for CAH patients is well tolerated and is successful in toddlers, with low (7.6%) complication rate. Revision surgery has successful outcome both functionally and cosmetically. In toilet-trained girls, urinary continence can be achieved in all patients following feminizing genitoplasty.
OBJECTIVE: To review the intermediate- to long-term surgical complications following feminizing reconstructive surgery for patients with congenital adrenal hyperplasia (CAH) at a single tertiary center. Genitourinary reconstructive surgery is pivotal to favorable cosmetic and functional outcomes for patients with CAH. MATERIALS AND METHODS: We conducted a retrospective review identifying 26 patients from April 2003 to April 2015 who underwent genitourinary reconstructive surgeries. Demographic data and surgical postoperative complications (per Unplanned Postoperative Morbidity in Children [UPMC] and Clavien-Dindo classification) were evaluated. RESULTS: The average age at the time primary surgery was done at our institute was 17 ± 20 (5-87) months; the average length of follow-up was 72.56 ± 36.95 (4.5-142) months. The average length of the common urogenital sinus was 4.5 ± 1.9 (2.5-6.4) cm, and 15 out of 22 (68%) patients had high confluence. A total of 7 complications were observed in 7 (27%) patients, 3 patients had Clavien grade I and UPMC 0 (dysuria, stitch dehiscence, wound separation), and 2 had Clavien grade II and UPMC 1 (urinary tract infection). Two (7.6%) patients required revision surgery, and both of them had Clavien grade IIIB. One patient had UPMC score 5 (suprapubic tube insertion for urinary retention secondary to cicatrization of the surgical site). CONCLUSION: Genitourinary reconstructive surgery for CAH patients is well tolerated and is successful in toddlers, with low (7.6%) complication rate. Revision surgery has successful outcome both functionally and cosmetically. In toilet-trained girls, urinary continence can be achieved in all patients following feminizing genitoplasty.
Authors: K J Bernabé; N J Nokoff; D Galan; D Felsen; C E Aston; P Austin; L Baskin; Y-M Chan; E Y Cheng; D A Diamond; R Ellens; A Fried; S Greenfield; T Kolon; B Kropp; Y Lakshmanan; S Meyer; T Meyer; A M Delozier; L L Mullins; B Palmer; A Paradis; P Reddy; K J Scott Reyes; M Schulte; J M Swartz; E Yerkes; C Wolfe-Christensen; A B Wisniewski; D P Poppas Journal: J Pediatr Urol Date: 2018-02-02 Impact factor: 1.921