Total urogenital sinus mobilization for ambiguous genitalia

Jesus, Vinicius Menezes; Buriti, Francisco; Lessa, Rodrigo Oliveira; Toralles, Maria Betânia Pereira; Oliveira, Luciana Barros; Barroso, Ubirajara

doi:10.1016/j.jpedsurg.2017.08.014

Cited by 12 publications

(5 citation statements)

References 22 publications

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“…A total of 29 records (38.7%) included medical photographs of the patient’s body or body parts. In most cases, they were close-ups of genitals—mainly from infants or children (AbouZeid & Mohammad, 2020 ; Barham et al, 2016 ; Baskin, 2017 ; Deeb et al, 2016 ; Fadil Iturralde et al, 2020 ; Goncalves et al, 2019 ; Heo et al, 2018 ; Jayanthi et al, 2017 ; Jesus et al, 2018 ; Kearsey & Hutson, 2017 ; Marei et al, 2016 ; Matsumoto et al, 2017 ; Morozumi et al, 2018 ; Nasir et al, 2019 ; Ochi et al, 2019 ; Saikia et al, 2019 ; Şimşek et al, 2016 ; Sperling & Meyer, 2017 ; Wagner-Mahler et al, 2019 ), but in a few cases also of adolescents (Chouhan et al, 2017 ; Hunter et al, 2016 ; Tambo et al, 2016 ) and adults (Larios García & Bautista Delgado, 2016 ; Patil et al, 2019 ; Singh et al, 2016 ). Three papers also contained images of breasts (Singh et al, 2016 ) and/or fully body shots (Khare et al, 2017 ; Mirshahvalad et al, 2018 ) of adolescents whose eyes were obscured with a black line.…”

Section: Resultsmentioning

confidence: 99%

“Waking up” the sleeping metaphor of normality in connection to intersex or DSD: a scoping review of medical literature

Clercq

Starke

Rost

2022

HPLS

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The aim of the study is to encourage a critical debate on the use of normality in the medical literature on DSD or intersex. For this purpose, a scoping review was conducted to identify and map the various ways in which “normal” is used in the medical literature on DSD between 2016 and 2020. We identified 75 studies, many of which were case studies highlighting rare cases of DSD, others, mainly retrospective observational studies, focused on improving diagnosis or treatment. The most common use of the adjective normal was in association with phenotypic sex. Overall, appearance was the most commonly cited criteria to evaluate the normality of sex organs. More than 1/3 of the studies included also medical photographs of sex organs. This persistent use of normality in reference to phenotypic sex is worrisome given the long-term medicalization of intersex bodies in the name of a “normal” appearance or leading a “normal” life. Healthcare professionals should be more careful about the ethical implications of using photographs in publications given that many intersex persons describe their experience with medical photography as dehumanizing.

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Section: Resultsmentioning

confidence: 99%

“Waking up” the sleeping metaphor of normality in connection to intersex or DSD: a scoping review of medical literature

Clercq

Starke

Rost

2022

HPLS

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“…5 Common UGS can also be associated with other signs of virilization of the external genitalia, such as clitoral hypertrophy, and scrotalization of the labia majora with a large variation of phenotype, from mild clitoromegaly without a common UGS to complete Prader V virilization with a long length of UGS. 1,6…”

Section: Persistent Urogenital Sinusmentioning

confidence: 99%

“…Similar to the cloacal patient, the length of the urogenital sinus and the distance from the confluence of the structures to the perineal skin greatly impacts the surgical approach in patients with common urogenital sinus. 1,6 In patients with a low confluence, vaginoplasty utilizing a perineal skin flap to the spatulated posterior urethra may be adequate to bring both orifices to the level of the skin. 9 Total urogenital sinus mobilization (TUM) may be necessary for patients with high confluence, the UGS being dissected circumferentially as a single unit in order to bring the confluence anteriorly to the level of the perineal skin.…”

Section: Anatomic Implications For Surgical Managementmentioning

confidence: 99%

3D Fluoroscopic imaging facilitates reconstruction of common urogenital sinus and cloacal anomalies

Li¹

2022

Insight Urol

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Cloacal anomalies and common urogenital sinus are rare structural abnormalities in hindgut and urogenital development. Surgical correction in childhood is often indicated to create normal external genital anatomy, allow for adequate bladder and vaginal drainage, and create the appropriate anorectal opening in patients with persistent cloaca. Understanding the anatomy and relationships between the pelvic organs is critical as there is a drastic variation in potential surgical approaches to the repair. Traditional imaging modalities such as pelvic ultrasound, magnetic resonance imaging, and two-dimensional fluoroscopic imaging have been utilized to delineate the pelvic anatomy for facilitation of surgical planning. Limitations to these modalities include the inability to adequately dilate structures and the difficulty in identifying the common confluence, or where the structures ultimately coalesce within the pelvis. In this article we describe the utilization of three-dimensional rotational fluorosco- py in combination with examination under anesthesia to provide optimal clarity of anatomy. Examination under anesthesia, specifically cystoscopy and vaginoscopy, helps the surgeon to visualize the anatomy and to place catheters in the correct lumens. Contrast material can then be injected into the catheters to dilate the bladder, vagina, and mucous fistula for fluoroscopic imaging. The rotational images can then be reconstructed in three dimensions to create a roadmap for the surgeons, providing accurate description of the location of the confluence, distance to the introitus and other critical measurements. We believe that three-dimensional rotation fluoroscopy is an underutilized diagnostic modality in the evaluation and surgical planning in patients with urogenital sinus and cloacal anomalies and should be considered by surgeons prior to proceeding with corrective surgery.

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“…Также необходимо отметить, что отдаленные результаты при использовании новых техник, прежде всего, мобилизации урогенитального синуса, все еще не опубликованы, но сообщения о непосредственных и среднесрочных результатах внушают оптимизм [11,[47][48][49][50].…”

Section: хирургическое лечениеunclassified

Disorders of sex differentiation: state of the problem 15 years after the Chicago consensus

Shiryaev

Kagantsov

Сизонов

2020

Probl Endokrinol (Mosk)

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It is well known that the nomenclature and classification were changed in 2005 at the international consensus conference on intersex disorders, held in Chicago, where, among others, the following recommendations were proposed: (1) all children should be assigned a gender identity, and this should be done as quickly as possible, taking into account the time required for the examination. (2) all infants with congenital adrenal hyperplasia and 46,XX karyotype, including those with pronounced masculinization, must be raised as women. (3) Surgical treatment should be performed early and in cases of feminizing genitoplasty, clitoral reduction should be performed simultaneously with reconstruction of the urogenital sinus (separation of the vagina and urethra). An analysis of contemporary literature shows that all these theories, proposed 15 years ago at the Chicago meeting, failed to stand the test of time. New nomenclature and classification are constantly being revised. Currently, many groups of patients want to abolish the term sexual maturity disorders. Recommendations regarding gender reassignment and appropriate early surgical treatment have been completely ignored in some countries. All this was largely facilitated by the confrontational activities of a number of support groups.

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Total urogenital sinus mobilization for ambiguous genitalia

Cited by 12 publications

References 22 publications

“Waking up” the sleeping metaphor of normality in connection to intersex or DSD: a scoping review of medical literature

“Waking up” the sleeping metaphor of normality in connection to intersex or DSD: a scoping review of medical literature

3D Fluoroscopic imaging facilitates reconstruction of common urogenital sinus and cloacal anomalies

Disorders of sex differentiation: state of the problem 15 years after the Chicago consensus

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