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Urinary continence after high urogenital sinus repair conducted with posterior prone approach: electromyography-uroflowmetric assessment

  • Urology - Original Paper
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Abstract

Purpose

We aimed to present the results of urinary continence assessment objectively with electromyography (EMG)-uroflowmetry after high urogenital sinus (HUGS) repair with posterior prone approach without division of rectum.

Methods

The records of patients who underwent HUGS repair via posterior prone approach between January 2005 and July 2018 were reviewed retrospectively. Incontinence, dysuria, hesitation, and straining during urination were evaluated during the clinical follow-up. Dysfunctional voiding scoring system was used as a questionnaire. Patients were re-evaluated with EMG-uroflowmetry in terms of voiding volume and pattern, voiding time, maximum flow rate, average flow rate, maximum flow time, and post-voiding residual volume.

Results

Seven patients with HUGS were treated with a posterior prone approach. The median age of the patients was 18 months (8–21 months). The median UGS length was 4.4 cm (3.6–5.5 cm), urethral length was 1.1 cm (1.0–1.5 cm), and vaginal length was 4.9 cm (4.1–5.1 cm). No urination or defecation problems were described by the patients or their parents. When the results of the dysfunctional voiding scoring systems questionnaire were analyzed, results scored 7 (range 5–8). EMG-uroflowmetric test graphics of the patients showed normal flow curves without plateau, intermittency or irregularity. Pelvic EMG assessment was normal in all patients.

Conclusion

EMG-uroflowmetry has shown objectively that urinary continence and normal voiding pattern are preserved after HUGS repair with posterior prone approach without division of rectum.

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References

  1. Hardy Hendren W, Crawford JD (1969) Adrenogenital syndrome: the anatomy of the anomaly and its repair. Some new concepts. J Pediatr Surg 4(1):49–58

    Article  Google Scholar 

  2. Peña A, Filmer B, Bonilla E, Mendez M, Stolar C (1992) Transanorectal approach for the treatment of urogenital sinus: preliminary report. J Pediatr Surg 27(6):681–685

    Article  Google Scholar 

  3. Rink RC, Pope JC, Kropp BP, Smith ER Jr, Keating MA, Adams MC (1997) Reconstruction of the high urogenital sinus: early perineal prone approach without division of the rectum. J Urol 158(3 Pt 2):1293–1297

    CAS  PubMed  Google Scholar 

  4. González R, Ludwikowski B (2012) Management of the high urogenital sinus—risk of overexposure? J Urol 187(3):787–788

    Article  Google Scholar 

  5. Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P et al (2016) The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society. Neurourol Urodyn 35(4):471–481

    Article  Google Scholar 

  6. Prader A (1958) Incidence of congenital adrenogenital syndrome. Helv Paediatr Acta 13(5):426–431

    CAS  PubMed  Google Scholar 

  7. Shalaby M, Chandran H, Elford S, Kirk J, McCarthy L (2021) Recommendations of patients and families of girls with 46XX congenital adrenal hyperplasia in the United Kingdom regarding the timing of surgery. Pediatr Surg Int 37:137–143

    Article  Google Scholar 

  8. Farhat W, Bägli DJ, Capolicchio G, O’Reilly S, Merguerian PA, Khoury A et al (2000) The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol 164(3 Pt 2):1011–1015

    Article  CAS  Google Scholar 

  9. Ha JS, Lee YS, Han SW, Kim SW (2020) The relationship among flow index, uroflowmetry curve shape, and EMG lag time in children. Neurourol Urodyn 39(5):1387–1393

    Article  Google Scholar 

  10. Peña A (1997) Total urogenital mobilization–an easier way to repair cloacas. J Pediatr Surg 32(2):263–267

    Article  Google Scholar 

  11. Fares AE, Marei MM, Abdullateef KS, Kaddah S, El Tagy G (2019) Laparoscopically assisted vaginal pull-through in 7 cases of congenital adrenal hyperplasia with high urogenital sinus confluence: early results. J Laparoendosc Adv Surg Tech A 29(2):256–260

    Article  Google Scholar 

  12. Park S, Ha SH, Kim KS (2011) Long-term follow-up after feminizing genital reconstruction in patients with ambiguous genitalia and high vaginal confluence. J Korean Med Sci 26(3):399

    Article  Google Scholar 

  13. Podesta M, Urcullo J (2008) Perineal mobilization of the common urogenital sinus for surgical correction of high urethrovaginal confluence in patients with intersex disorders. J Pediatr Urol 4(5):352–358

    Article  Google Scholar 

  14. Dangle PP, Lee A, Chaudhry R, Schneck FX (2017) Surgical complications following early genitourinary reconstructive surgery for congenital adrenal hyperplasia—interim analysis at 6 years. Urology 101:111–115

    Article  Google Scholar 

  15. Zaparackaite I, Barauskas V, Nielsen OH, Jokela R (2002) Adrenogenital syndrome: feminizing genital reconstruction. Medicina (Kaunas) 38(7):706–711

    Google Scholar 

  16. Salle JL, Lorenzo AJ, Jesus LE, Leslie B, AlSaid A, Macedo FN et al (2012) Surgical treatment of high urogenital sinuses using the anterior sagittal transrectal approach: a useful strategy to optimize exposure and outcomes. J Urol 187(3):1024–1031

    Article  Google Scholar 

  17. Fagerholm R, Rintala R, Taskinen S (2013) Lower urinary tract symptoms after feminizing genitoplasty. J Pediatr Urol 9(1):23–26

    Article  Google Scholar 

  18. Bailez MM, Cuenca ES, Dibenedetto V (2014) Urinary continence following repair of intermediate and high urogenital sinus (UGS) in CAH. Experience with 55 cases. Front Pediatr 2:67

    Article  Google Scholar 

  19. Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P (1996) The bristol female lower urinary tract symptoms questionnaire: development and psychometric testing. Br J Urol 77(6):805–812

    Article  CAS  Google Scholar 

  20. Davies MC, Crouch NS, Woodhouse CR, Creighton SM (2005) Congenital adrenal hyperplasia and lower urinary tract symptoms. BJU Int 95(9):1263–1266

    Article  Google Scholar 

  21. Rodríguez LV, Blander DS, Dorey F, Raz S, Zimmern P (2003) Discrepancy in patient and physician perception of patient’s quality of life related to urinary symptoms. Urology 62(1):49–53

    Article  Google Scholar 

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey

    Oktay Ulusoy, Serra Sabuncu, Osman Zeki Karakuş, Oğuz Ateş, Gülce Hakgüder, Mustafa Olguner & Feza Miraç Akgür

  2. Division of Pediatric Urology, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey

    Oğuz Ateş, Gülce Hakgüder, Mustafa Olguner & Feza Miraç Akgür

Authors
  1. Oktay Ulusoy
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  2. Serra Sabuncu
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  3. Osman Zeki Karakuş
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  4. Oğuz Ateş
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  5. Gülce Hakgüder
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  6. Mustafa Olguner
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  7. Feza Miraç Akgür
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by OU, SS, OZK. The first draft of the manuscript was written by OU, OA, GH, MO, FMA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Oktay Ulusoy.

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There are no conflicts of interest associated with this publication. The authors declare they have no financial interests.

Ethical approval

The Institutional Ethics Review Board for Clinical Research approved this study (4631-GOA-2019/07-09).

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Informed consent was obtained from parents or legal guardians.

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Ulusoy, O., Sabuncu, S., Karakuş, O.Z. et al. Urinary continence after high urogenital sinus repair conducted with posterior prone approach: electromyography-uroflowmetric assessment. Int Urol Nephrol 53, 1813–1818 (2021). https://doi.org/10.1007/s11255-021-02895-7

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