Skip to main content
Top
Published in: Aesthetic Plastic Surgery 3/2014

01-06-2014 | Case Report

Surgical Reconstruction of the Genitalia in a 3-Year-Old Infant with a 46XX Karyotype: Case Report

Authors: Horea Gozar, Ionela Pascanu, Mircea Ardelean, Simona Gurzu, Zoltan Derzsi

Published in: Aesthetic Plastic Surgery | Issue 3/2014

Login to get access

Abstract

A 3-year-old patient was hospitalized with ambiguous genitalia (clitoromegaly, labioscrotal fusion, absence of vaginal introitus), classified as stage III/IV according to Prader’s virilization scale. Our patient, with a 46XX karyotype, was previously diagnosed with congenital adrenal hyperplasia caused by a deficiency of the adrenal enzyme 21-hydroxylase; corticosteroids and salt replacement therapy have been used. At the present admission, the surgical treatment consisted on clitoroplasty (with the removal of erectile tissue), reconstruction of the labia minor, creation of a neovulva and vaginoplasty. It was a single-step operation to restore the anatomical female structures. She had an uneventful postoperative period and the wound healed well with good cosmetic results. We present the details about the surgical procedure and a short review of data from literature.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
go back to reference White PC, Speiser PW (2000) Congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Endocrinol Rev 21:3245–3291 White PC, Speiser PW (2000) Congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Endocrinol Rev 21:3245–3291
2.
go back to reference Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, Meyer-Bahlburg HF, Miller WL, Montori VM, Oberfield SE, Ritzen M, White PC (2010) Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 95:4133–4160PubMedCentralPubMedCrossRef Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, Meyer-Bahlburg HF, Miller WL, Montori VM, Oberfield SE, Ritzen M, White PC (2010) Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 95:4133–4160PubMedCentralPubMedCrossRef
3.
go back to reference Bonfig W, Bechtold S, Schmidt H, Knorr D, Schwarz HP (2007) Reduced final height outcome in congenital adrenal hyperplasia under prednisone treatment: deceleration of growth velocity during puberty. J Clin Endocrinol Metab 92:1635–1639PubMedCrossRef Bonfig W, Bechtold S, Schmidt H, Knorr D, Schwarz HP (2007) Reduced final height outcome in congenital adrenal hyperplasia under prednisone treatment: deceleration of growth velocity during puberty. J Clin Endocrinol Metab 92:1635–1639PubMedCrossRef
4.
go back to reference Schnitzer JJ, Donahoe PK (2001) Surgical treatment of congenital adrenal hyperplasia. Endocrinol Metab Clin North Am 30:137–154PubMedCrossRef Schnitzer JJ, Donahoe PK (2001) Surgical treatment of congenital adrenal hyperplasia. Endocrinol Metab Clin North Am 30:137–154PubMedCrossRef
5.
go back to reference Krege S, Walz KH, Hauffa BP, Körner I, Rübben H (2000) Long-term follow-up of female patients with congenital adrenal hyperplasia from 21-hydroxylase deficiency, with special emphasis on the results of vaginoplasty. BJU Int 86:253–259PubMedCrossRef Krege S, Walz KH, Hauffa BP, Körner I, Rübben H (2000) Long-term follow-up of female patients with congenital adrenal hyperplasia from 21-hydroxylase deficiency, with special emphasis on the results of vaginoplasty. BJU Int 86:253–259PubMedCrossRef
6.
go back to reference White PC, Speiser PW (2000) Congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Endocr Rev 21:245–291PubMed White PC, Speiser PW (2000) Congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Endocr Rev 21:245–291PubMed
7.
go back to reference Rocha RO, Billerbeck AE, Pinto EM, Melo KF, Lin CJ, Longui CA, Mendonca BB, Bachega TA (2008) The degree of external genitalia virilization in girls with 21-hydroxylase deficiency appears to be influenced by the CAG repeats in the androgen receptor gene. Clin Endocrinol 68:226–232 Rocha RO, Billerbeck AE, Pinto EM, Melo KF, Lin CJ, Longui CA, Mendonca BB, Bachega TA (2008) The degree of external genitalia virilization in girls with 21-hydroxylase deficiency appears to be influenced by the CAG repeats in the androgen receptor gene. Clin Endocrinol 68:226–232
8.
go back to reference Park S, Ha SH, Kim KS (2011) Long-term follow-up after feminizing genital reconstruction in patients with ambiguous genitalia and high vaginal confluence. J Korean Med Sci 26:399–403PubMedCentralPubMedCrossRef Park S, Ha SH, Kim KS (2011) Long-term follow-up after feminizing genital reconstruction in patients with ambiguous genitalia and high vaginal confluence. J Korean Med Sci 26:399–403PubMedCentralPubMedCrossRef
9.
11.
go back to reference Acimi S (2013) Vaginoplasty using the inner surface or mucosa of the prepuce in children with congenital adrenal hyperplasia. J Pediatr Urol 9(6 Pt B):1038–1042PubMedCrossRef Acimi S (2013) Vaginoplasty using the inner surface or mucosa of the prepuce in children with congenital adrenal hyperplasia. J Pediatr Urol 9(6 Pt B):1038–1042PubMedCrossRef
12.
go back to reference Jenak R, Ludwikowski B, Gonzalez R (2001) Total urogenital sinus mobilization: a modified perineal approach for feminizing genitoplasty and urogenital sinus repair. J Urol 165:2347–2349PubMedCrossRef Jenak R, Ludwikowski B, Gonzalez R (2001) Total urogenital sinus mobilization: a modified perineal approach for feminizing genitoplasty and urogenital sinus repair. J Urol 165:2347–2349PubMedCrossRef
13.
go back to reference Pippi Salle JL, Braga LP, Macedo N, Bagli D (2007) Corporeal sparing dismembered clitoroplasty: an alternative technique for feminizing genitoplasty. J Urol 178:1796–1800PubMedCrossRef Pippi Salle JL, Braga LP, Macedo N, Bagli D (2007) Corporeal sparing dismembered clitoroplasty: an alternative technique for feminizing genitoplasty. J Urol 178:1796–1800PubMedCrossRef
14.
go back to reference Fagerholm R, Rintala R, Taskinen S (2013) Lower urinary tract symptoms after feminizing genitoplasty. J Pediatr Urol 9:23–26PubMedCrossRef Fagerholm R, Rintala R, Taskinen S (2013) Lower urinary tract symptoms after feminizing genitoplasty. J Pediatr Urol 9:23–26PubMedCrossRef
15.
go back to reference Fagerholm R, Mattila AK, Roine RP, Sintonen H, Taskinen S (2012) Mental health and quality of life after feminizing genitoplasty. J Pediatr Surg 47:747–751PubMedCrossRef Fagerholm R, Mattila AK, Roine RP, Sintonen H, Taskinen S (2012) Mental health and quality of life after feminizing genitoplasty. J Pediatr Surg 47:747–751PubMedCrossRef
Metadata
Title
Surgical Reconstruction of the Genitalia in a 3-Year-Old Infant with a 46XX Karyotype: Case Report
Authors
Horea Gozar
Ionela Pascanu
Mircea Ardelean
Simona Gurzu
Zoltan Derzsi
Publication date
01-06-2014
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 3/2014
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-014-0321-7

Other articles of this Issue 3/2014

Aesthetic Plastic Surgery 3/2014 Go to the issue

Editor's Invited Commentary

Suspension Sutures for Neck Rejuvenation