Lower urinary tract symptoms after feminizing genitoplasty
Introduction
In females with disorders of sexual differentiation (DSD), the lower urinary tract can also be affected. In patients with complete androgen insensitivity the urethra is usually normal, while patients with prenatal androgen exposure often have a common urogenital sinus of variable length [1], [2] Congenital adrenal hyperplasia (CAH) is the most common reason for prenatal androgen exposure [2]. Urogenital sinus in CAH patients has traditionally been treated with a dorsal split with or without an inverted U-shaped flap. Today a common approach is the en-bloc urogenital sinus mobilization [3], [4], [5]. Stenosis of the vaginal introitus is reported to be common after the dorsal flap procedure [6], but the urethra itself should be unaffected in U-flap operations. However, increased prevalence of lower urinary tract symptoms (LUTS) in CAH patients has been reported in some [7], [8], but not in all studies [9]. Major feminizing surgery is not often needed in patients with androgen insensitivity syndrome (AIS), but there may be a need for vaginal reconstruction or vaginal dilatations. We have not found previous published studies on LUTS in AIS patients.
In our clinical practice we have not noted especially severe LUTS in female DSD patients. Because of previous contradictory results, we aimed to evaluate the prevalence of LUTS in adult females who had undergone surgery either because of CAH or AIS in comparison with healthy females.
Section snippets
Patients and methods
The hospital database of the Hospital for Children and Adolescents, University of Helsinki, was retrospectively reviewed for CAH and AIS patients from1980 to 2000. Forty-five post-pubertal patients older than 15 years were identified and were mailed a questionnaire up to three times to assess the prevalence of LUTS. Twenty-four patients (53%) returned the questionnaire. Sixteen of the 24 patients had prenatal androgen exposure and 46, XX karyotype (CAH group), and eight patients had 46, XY
Results
Distressing LUTS were reported by six of the 16 (38%) patients in the CAH group, by one of the eight (13%) patients in the AIS group and by 22 of the 46 (48%) controls. In the CAH group the distress caused by any LUTS was small in four patients (25%), moderate in two patients (13%), and major in none. The only AIS patient with distressing LUTS reported moderate degree of symptoms. In the controls the distress caused by any LUTS was small in 15 (33%), moderate in six (13%) and major in one (2%).
Discussion
In this study, occasional LUTS were common both in the patients and in the controls and we did not find significant differences between the groups. In previous studies with DSD patients the occurrence of LUTS has been variable. In a study where the Bristol female incontinence questionnaire was used, 68% of the patients with CAH had urge urinary incontinence and 47% had stress incontinence compared to controls with 16% of urge incontinence and 26% of stress incontinence [7], [12]. In that study
Conflict of interest/funding
None.
References (14)
- et al.
Congenital adrenal hyperplasia: preliminary observations of the urethra in 9 cases
J Urol
(2002) - et al.
Urinary continence is well preserved after total urogenital mobilization
J Urol
(2004) - et al.
Prospective evaluation of feminizing genitoplasty using partial urogenital sinus mobilization for congenital adrenal hyperplasia
J Urol
(2006) - et al.
Psychosexual outcome in women affected by congenital adrenal hyperplasia due to 21-hydroxylase deficiency
J Urol
(2004) - et al.
Sexual function and attitudes toward surgery after feminizing genitoplasty
J Urol
(2011) - et al.
Urinary tract infection: self-reported incidence and associated costs
Ann Epidemiol
(2000) - et al.
A new classification for genital ambiguity and urogenital sinus anomalies
BJU Int
(2005)
Cited by (13)
The Association between Surgeon Dissatisfaction with Infant Genital Appearance and Surgical Decision-Making Surrounding Clitoroplasty
2023, Journal of Pediatric and Adolescent GynecologySexual function and voiding status following one stage feminizing genitoplasty
2020, Journal of Pediatric UrologyCitation Excerpt :These findings were significantly correlated with female sexual function. Another intriguing issue in this group of patients is LUTS appearance following FG [21,22]. In our clinical practice, we have not noted severe LUTS in female DSD patients.
Long-term urinary symptoms in adolescent and adult women with congenital adrenal hyperplasia
2018, Journal of Pediatric UrologyCitation Excerpt :The only other published study to have utilised a standardised and validated questionnaire for data collection found no increased rates of lower urinary tract symptoms in patients with CAH when compared to the general population [16]. Although the current study had a relatively small sample size and low participant response rate, previous studies have suffered from the same limitations [15,16]. This may raise concerns over the prevalence of urinary symptoms in non-participants and thus the quality of data collected in the current study.
Urinary Incontinence - An Unusual Indication for Early Vaginoplasty in Late Presenting Congenital Adrenal Hyperplasia
2013, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Controversy exists regarding the timing and extent of genital reconstructive surgery.2–4 Early surgery precludes the possibility of informed consent and may be associated with greater risk of later complications, impaired sexual function and requiring revisional surgery.5–7 Although proponents of early surgery argue that it has benefits for both the family's psychological well-being and the patient's psycho-sexual and social development, the decision-making is clearly multifactorial and should be considered on an individual basis following a careful discussion with all parties involved.8