Lower urinary tract symptoms after feminizing genitoplasty

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Abstract

Objective

To investigate the prevalence of lower urinary tract symptoms (LUTS) in a Finnish cohort of patients who had undergone feminizing genitoplasty in childhood.

Patients and methods

Information on LUTS was assessed using the Danish Prostatic Symptom Score questionnaire: 24 out of 45 females (53%) returned the questionnaire; 16 patients with prenatal androgen exposure (congenital adrenal hyperplasia = CAH group) and eight with androgen insensitivity (AIS group).

Results

Urge urinary incontinence was reported by 13% of the patients in both the CAH and AIS groups and by 15% of the controls. Stress urinary incontinence was reported by 31% of the patients in the CAH group, 13% of the patients in the AIS group and 22% of the controls. Distressing voiding symptoms were reported by 19% of the patients in the CAH group, 13% of the patients in the AIS group and 28% of the controls, and of these straining and incomplete emptying were the most prevalent.

Conclusions

LUTS are as common in female DSD patients with feminizing genitoplasty as they are in controls. Some degree of distressing incontinence occurred in 13%–25% of the young female patients and the controls.

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)

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Cited by (13)

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    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.

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  • Urinary Incontinence - An Unusual Indication for Early Vaginoplasty in Late Presenting Congenital Adrenal Hyperplasia

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    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

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