Transabdominal pelvic sonography in the preoperative evaluation of patients with congenital adrenal hyperplasia

Abstract

Purpose We assessed the clinical value of transabdominal pelvic sonography in the preoperative evaluation of patients with congenital adrenal hyperplasia (CAH) who required feminizing genitoplasty. Methods From 1987 to 1998, 31 patients with female pseudohermaphroditism due to CAH underwent feminizing genitoplasty. The median age of the patients was 9 months (range, 1–18 years). Radiologic evaluation performed before surgical reconstruction included retrograde genitography in the first 10 patients and sonographic examination in all 31 patients. Imaging was used to evaluate the anatomic positions and the length of the vagina, whether the junction of the vagina and the urogenital sinus occurred distal or proximal to the pelvic floor, and the presence of internal genitalia. Results Abdominal sonography identified internal female genitalia in all 31 patients, identified the anatomic shape and position of the vagina in 30 patients (97%), and confirmed the site of communication between the vagina and the urogenital sinus relative to the pelvic floor in 28 patients (90%). Sonographic findings were confirmed by intraoperative panendoscopy. Genitography was less useful than sonography, identifying the site of communication between the vagina and urogenital sinus in only 6 (60%) of 10 patients. Conclusions In patients with CAH undergoing vaginal reconstruction, sonography provides adequate information about the anatomy of the vagina and urogenital sinus for surgical decision‐making. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:122–124, 2000.

Feminizing genitoplasty in congenital adrenal hyperplasia

“…In our study, a lower ultrasound sensitivity of 71.4% was reported. This is close to the results reported by other studies (60% by Chertin et al [17], 55.6% by Elhalaby [18] and 72% by Vanderbrink et al [19]). However, the sensitivity obtained by us is very close to the sensitivity of 77.8% reported by Elhalaby [18].…”

“…The abdominal sonography technique is found to have a sensitivity of 100% in identification of internal female genitalia [17]. In our study, a lower ultrasound sensitivity of 71.4% was reported.…”

Feminizing Genitoplasty in Patients with 46XX Congenital Adrenal Hyperplasia

“…The technique and the results of sonography in our unit have been previously published 15 . To obtain the necessary information and to spare the child from anxiety and exposure to ionizing radiation, we now routinely perform only sonographic examination in our CAH patients.…”

The role of imaging in congenital adrenal hyperplasia

“…Ultrasound evaluation of the pelvic structures is not only performed for diagnosis but also as part of the preoperative approach for surgery, often in conjunction with other exams, such as genitography and MRI (3). US provides adequate information about the vagina and urogenital sinus for preoperative decision-making (28).…”