A Novel Technique Of Reduction Clitoroplasty.

The purpose of this paper is: To introduce a novel surgical technique of reduction clitoroplasty. In this study, ten patients, known cases of congenital adrenal hyperplasia with clitoromegaly were operated for reduction clitoroplasty. In our technique, the phallus was degloved till the base and plicating sutures were taken from the base of crura to the shaft of the clitoris to the subcoronal mucosa. It was observed that this technique had good cosmetic results and patient satisfaction.

CLITOROPLASTY FOR GENITAL VIRILIZATION IN GIRLS WITH CONGENITAL ADRENAL HYPERPLASIA / 中国修复重建外科杂志

OBJECTIVE: To investigate the effectiveness of clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate for genital virilization in girls with congenital adrenal hyperplasia (CAH). METHODS: Between June 2000 and October 2015, 27 girls with genital virilization were treated with clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate. The chromosomal karyotype was 46, XX in all patients, whose age ranged from 3 to 11 years (mean, 3.9 years). According to Parder's virilization scale, 5 cases were classified as stage Ⅱ, 18 cases as stage Ⅲ, and 4 cases as stage Ⅳ. The hormone tests showed decreased cortisol level and increased testosterone and 17-hydroxyprogesterone levels. They were diagnosed with non-salt-wasting CAH. RESULTS: All of the patients underwent clitoroplasty successfully. The mean operation time was 74 minutes (range, 58-95 minutes). Incision healed primarily. The patients were followed up 6 months to 10 years (median, 19 months). The external genitalia had good appearance, without necrosis of flap and the glans clitoris, abnormal sensation of the glans clitoris, or clitorism recurrence. Five girls had breast development and normal menstrual cycle during adolescence, and 1 patient who was followed up for 10 years gave birth to a son. CONCLUSIONS: Clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate is a relatively ideal method for treating genital virilization in girls. It has less complications, good aesthetic and functional results. There are satisfactory outcomes when combining with the endocrine treatment.

Clitoromegalia: quiste epidermoide de clítoris / Clitoromegaly: epidermal cyst of clitoris

Objetivo: Describir un caso de clitoromegalia en una mujer perimenopáusica. Lugar: Centro de Tercer Nivel de Atención. Intervenciones: Resonancia magnética, ultrasonido pélvico, marcadores tumorales, clitoroplastia con resección quirúrgica de quiste epidermoide. Resultados: Clitoroplastia más resección de tumor epidermoide con preservación de la anatomía y sensibilidad. Conclusión: Paciente femenina de 52 años, sin antecedentes de trauma pélvico, quien desarrolló un caso inusual de clitoromegalia sin dolor u otros síntomas, además de un notorio crecimiento tumoral en los últimos cuatro años en el cual la malignidad fue descartada. Hay pocos casos de quistes epidermoides en ausencia de trauma o mutilación de genitales reportados en la literatura; generalmente son solitarios, de crecimiento lento y asintomáticos, localizados usualmente en la piel, el cuello o el tronco del clítoris. El procedimiento realizado fue una clitoroplastia con resección del quiste epidermoide, en el cual se ha preservado tanto la anatomía como la sensibilidad sin complicaciones después de seis meses de seguimiento.

Objective: Describe a case of clitoromegaly in a perimenopausal female. Setting: Third Level Attention Center. Interventions: Magnetic resonance imaging, pelvic ultrasound, tumoral markers, clitoroplasty with surgical extirpation of epidermal cyst. Results: Clitoroplasty with surgical extirpation of epidermal cyst and preservation of the anatomy and sensitivity. Conclusions: A 52 years old female patient without history of pelvic trauma who developed an unusual case of clitoromegaly without pain nor any symptoms besides notorius tumor growing over past four years in which malignancy was discarded. There are very few epidermal cyst cases in the absence of trauma or genitalia mutilation reported in literature; they are usually solitary tumors, with slow growing and asymptomatic. Usually localized in clitoral scalp, neck or trunk. The performed procedure was a clitoroplasty with extirpation of an epidermal cyst, where has been well preserved the anatomy and sensitivity, without any complication after six months follow up.

Clinical effect of clitoroplasty with preservation of glans clitoris and dorsal neurovascular pedicle / 中华医学美学美容杂志

Objective To evaluate the clinical effect of clitoroplasty with preservation of the glans clitoris and the dorsal neurovascular pedicle in patients with clitoral hypertrophy. Methods From July 2003 to June 2009, cunnus feminization operations with preservation of the glans clitoris and the dorsal neurovascular pedicle and labioplasty were performed on 8 patients with female pseudohermaphroditism. Results All 8 cases were primary healing. The shaping glans of clitoris was completely viable with satisfactory size, location, contour and touching sensitivity, and the cunnuses presented the appearances of female external genital organs. Conclusions Clitoroplasty with preservation of the glans clitoris and the dorsal neurovascular can improve the appearance of clitoris and labia, preserving the functions of sensation and erection, reconstruting a new clitoris which is aesthetically appealing and functional, and it is suitable for various kinds of cunnus feminization operations.

Reduction Clitoroplasty with Preservation of Dorsal Neurovascular Pedicles

Conventional reduction clitoroplasty often leaves the glans clitoris without tactile sensation. Several clitoroplasty methods have been reported, but only a few describes preservation of dorsal neurovascular bundles. We present the case of 20-year- old female with symptomatic clitoromegaly since puberty, who underwent a clitoral reduction designed to preserve the neurovascular supply of the glans clitoris. The cosmetic outcome was excellent on postoperative examination and the patient reported normal sensation 6 months later. Preservation of?dorsal vascular pedicles showed a satisfactory result in sexually mature women.

First stage reconstruction of ambiguous external genitalia in children

The criteria for the identification of sex are as follows; sex chromosome and chromatin, gonadal structure, morphology of the external genitalia, morphology of the internal genitalia, hormonal status, sex of rearing and gender role. During these steps, any disturbance may be presented clinically as a disorder of intersexuality. Hermaphroditism is a state of having ambiguous genitalia due to abnormal sexual differentiation. We experienced three children with ambiguous external genitalia. Two patients were male pseudohemaphrodites, who had a normal male chromosomal constitution of 46XY with incomplete masculinization of the external genitalia and hypospadia. One patient was female pseudohemaphrodite, who had a normal female chromosomal constitution of 46XX with male phallus-like enlarged clitoris associated with posterior labial fusion and single perineal urogenital orifice. There was elevated urinary 17 ketosteriod and hypertrophied adrenal gland on CT scan. We planned staged reconstruction because they were children. First stage reconstruction were surgical restoration of the ambiguous external genitalia to normal appearance and removal of contradictory gonadal structure as early as possible. Second stage reconstruction includes reconstruction of secondary sex characteristics after puberty such as mammaplasty, vaginoplasty, and facial plasty. Hormonal therapy was necessary for normalization of hormonal status and promotion of expression of secondary sex characteristics. In first stage reconstruction, we performed clitoroplasty by use of glans penis island flap with dorsal neurovascular bundle, labioplasty and orchiectomy in two male hermaphroites. All neoclitoris survived well with good preservation of sensation.

FEMALE PSEUDOHERMAPHRODITISM DUE TO ADRENOGENITAL SYNDROME

Female pseudohermaphroditism due to adrenogenital syndrome is a condition in which individuals with a 46XX karyotype, negative H-Y antigen, normal mullerian duct derivatives, and a lack of development of w lffian duct structures differentiate partially as phenotypic males. They usually manifest masculinization of the external genitalia as a result of excess endogenous androgens. Most female pseudohermaphrodities have one of the types of congenital virilizing adrenal hyperplasia. Adrenogenital syndrome is inborn errors transmitted by autosomal recessive genes and may be due to defects in any of the enzymic steps in the biosynthesis of cortisol. Most affected individuals have a failure of 21-hydroxylation which prevents the conversion of 17 alpha-hydroxyprogesterone to 11-deoxycortisol. Such a defect in 21-hydroxylase leads to excessive production of adrenal androgens causing virilization. The treatment is early endocrinologic support and surgical reconstruction. There are some considerations in surgical repairs including normal sized clitoris with adequate erogenous sensation, sufficiently wide vaginal introitus and normal aesthetic appearance of the external genitalia for her normalized life as a female. We have experienced four cases of female pseudohermaphroditism due to adrenogenital syndrome. In two cases, we performed clitoroplasty with nerve sparing technique, vulvoplasty with mons pubis augmentation, vaginoplasty with posterior perineal flap and urethral reconstruction. In the other cases, we performed clitoroplasty with nerve sparing technique, vulvoplasty and vaginoplasty There was no specific operative complication and the result of the correction was satisfactory.

A Case of Clitoroplasty with Preserving Neurovascular Supply to the Clitoris for Clitoromegaly in Congenital Adrenal Hyperplasia / 대한산부인과학회잡지

Congenital adrenal hyperplasia, which is caused by the disorder of the enzyme for synthesizingadrenal hormones, results in hypertropy of the clitoris due to overporduction of adrenalandrogen. Diagnosis of the congenital adrenal hyperplasia can be obtained by the study ofsteroid levels in blood and urine. The blood levels of ACTH, testosterone and 17-hydroxyprogesteronewere increased and the concentration of 17-ketosteroid were decreased after the dexamethasonesuppression test. The internal genital organ was normal appearance on the pelvic CTscan. Clitoromegaly due to congenital adrenal byperplasia was corrected previously by the variousoperational procedures in which the clitoris was removed entirely for only physial appearance.However the sensitive function of the clitoris after the operative correction throughpuberty is to be preserved by the method "clitoroplasty" for preserving neurovascular supply tothe clitoris. The writer experienced a case of a 5-year-old girl with congenital adrenalhyperplasia and tried this clitoroplasty for surgical treatment of clitoromegly for preservation ofpostoperative sensitivity of the clitoris.

A Case of Reduction Clitoroplasty in Adrenogenital Syndrome / 대한비뇨기과학회지

Herein we presented a case of adrenogenital syndrome in 4-year-old female reconstructed by modified Allen-Spence clitoroplasty and vaginoplaty. She had a hypertrophied clitoris and a urogenital sinus into which the urethra and vagina both empty. Postoperative genital structures showed cosmetically good shape.