Aesthetic aspects of reconstructive clitoroplasty in females with bladder exstrophy–epispadias complex☆
Received 24 August 2009; accepted 1 February 2010. published online 19 March 2010. Corrected Proof
Summary
Background
Genital anomalies in females born with classic bladder exstrophy–epispadias complex (EEC) include a bifid clitoris and anterior displacement of vagina. The aesthetic aspects of the genitals acquire greater significance with age and may affect self-esteem. We review our experience with clitoral reconstruction in an EEC population with an emphasis on aesthetic outcomes.
Methods
The study group had 26 female patients; three patients with isolated epispadias and 23 with bladder exstrophy. The patients were separated into four separate groups based on reconstructive technique. Group 1 (n=3) had tubularisation of skin between clitoral bodies for urethral reconstruction; group 2 (n=12) underwent staged exstrophy reconstruction; group 3 (n=8) had initial surgery elsewhere and were referred for secondary reconstructive surgery with clitoroplasty accompanied by puboplasty to reconstruct the fourchette; and group 4 (n=3) had total urogenital sinus mobilisation. The aesthetic outcome was assessed subjectively by the surgeon, parent and age-appropriate patient during follow-up.
Results
A total of 33 clitoroplasties were performed. Primary clitoroplasty was performed in 18 patients, while a secondary clitoroplasty was done in 15. The follow-up ranged from 3 months to 31 years. Three patients had partial clitoral atrophy and in one patient the gap between clitoral bodies was widely separated and incapable of being joined. Twenty-three of the26 patients (88%) had a satisfactory or excellent aesthetic outcome following clitoroplasty.
Conclusions
Excellent aesthetic outcomes can be achieved by clitoroplasty in EEC patients by using a variety of surgical techniques. We recommend a ‘second look’ reassessment near puberty to identify poor cosmesis and offer secondary clitoroplasty to improve aesthetic outcome.
ABSTRACT
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