Total urogenital sinus mobilization: expanded applications.

Abstract

To report further applications of total urogenital sinus mobilization, earlier described as an easier method to correct a cloaca. 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 </=3 cm. 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). 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.