Laparoscopic-assisted vaginal pull-through: A new approach for congenital adrenal hyperplasia patients with high urogenital sinus
| Autor: | Véronique Tardy, Jacques Birraux, Claude Pierrette Le Coultre, Pierre-Yves Mure, Yves Morel, Pierre Mouriquand, Faustin Tambo Mouafo, Sophie Dahoun |
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| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
laparoscopy lcsh:Surgery Urinary incontinence Dissection (medical) medicine Humans ddc:576.5 Abnormalities Multiple Laparoscopy ddc:618 Pelvic floor Adrenal Hyperplasia Congenital medicine.diagnostic_test Urinary continence business.industry Congenital adrenal hyperplasia lcsh:RJ1-570 lcsh:Pediatrics lcsh:RD1-811 medicine.disease vaginal pull-through Anorectal Malformations Perineum Surgery Urethra medicine.anatomical_structure Child Preschool Vagina Pediatrics Perinatology and Child Health Original Article Female urogenital sinus medicine.symptom business |
| Zdroj: | African Journal of Paediatric Surgery, Vol 12, Iss 3, Pp 177-180 (2015) African Journal of Paediatric Surgery: AJPS African Journal of Paediatric Surgery, Vol. 12, No 3 (2015) pp. 177-180 |
| ISSN: | 0189-6725 0974-5998 |
| DOI: | 10.4103/0189-6725.170191 |
| Popis: | Background: To open vaginal cavity to the pelvic floor is part of surgical treatment for urogenital sinus (UGS) in girls with congenital adrenal hyperplasia (CAH). For high UGS, this operative procedure can be challenging and may jeopardise urinary continence. Combined perineal and laparoscopic approaches could be useful to minimise perineal dissection and to facilitate the vaginal lowering. Patients and Methods: We report the procedure of a laparoscopic-assisted vaginal pull-through for supra-sphincteric UGS in a 5-year-old girl with CAH. Laparoscopic dissection of the vagina from the posterior wall of the bladder and urethra, division of the confluence and vaginal pull-through to the perineum are described. Discussion: The technique is derived from laparoscopic-assisted treatment for high ano-rectal malformations. Compared with current procedures for treatment for high UGS, laparoscopic-assisted approach allows mobilising vagina with minimal dissection of perineum and complete preservation of urethra. Another major advantage is to provide a direct vision for dissection of the space between rectum and urethra prior to vaginal pull-through. Conclusion: Laparoscopic-assisted vaginal pull-through appears to be an interesting approach for high UGS in CAH patients, reducing dissection and risk of urinary incontinence. This new approach needs to be strengthened by other cases. |
| Databáze: | OpenAIRE |
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