Abdominoperitoneal approach to management of the high, short vagina in the adrenogenital syndrome.

Abstract

We describe a combined transtrigonal, abdominoperineal approach to the surgical management of the female pseudohermaphrodite with the adrenogenital syndrome and a high, short vagina. Most of our patients had undergone previous clitoral reduction surgery and, therefore, clitoral shaft skin was not available for exteriorization of the vagina. Our operation involves partial mobilization of the vagina through an inverted U flap from the perineum followed by detachment from the urogenital sinus from above by splitting the trigone. Exteriorization is accomplished by mobilizing 2 lateral skin flaps from the perineum and joining them with the inverted U flap to reach the vagina. Cosmetic results have been excellent, although anastomotic stenosis occurred in 1 young infant.