An insight into vaginal surgery in a severely masculinized CAH patient.

Reconstruction and exteriorization of the "high" vagina in girls with congenital adrenal hyperplasia (CAH) is technically challenging. Although current surgical thinking favors correction in infancy the evidence from several long-term studies indicates that many patients will require further surgery in adolescence or adult life. Deferred vaginoplasty has been advocated because the procedure may be technically easier as a consequence of changes in the characteristics of the genital tissues and vaginal anatomy.

An objective assessment of the results of hypospadias surgery.

Objective: To compare the cosmetic result of tubularized incised-plate urethroplasty (Snodgrass method) with that of two established techniques, the meatal-based flap and onlay island flap repair.

Subjects And Methods: Photographs of the penis after hypospadias repair in 32 boys were assessed by a panel of five independent health professionals, including four surgeons with variable paediatric urological experience and a urology nurse. Twenty patients had a distal and 12 a proximal meatus.

Management of müllerian duct remnants.

Objectives: To describe the presentation and radiologic investigation of 6 patients who had persistent müllerian duct remnants (MDRs) in association with severe hypospadias and to review the long-term results of surgical management using the transtrigonal approach.

Methods: The hospital records of 6 patients who had MDRs and who underwent transvesical transtrigonal excision were reviewed and long-term assessment of urinary control and continence was made by interview.

Results: One patient presented in the newborn period with clinically palpable MDRs and five others escaped detection until after the hypospadias repair, despite ultrasonography of the pelvis specifically looking for MDRs.