Daniel H. Teitelbaum, MD; John Park, MD; Kathleen Graziano, MD; Arnold G. Coran, MD
For female infants who suffer from a highly virilized state due to congenital adrenal hyperplasia, correction of the defect is often fraught with difficulty in gaining adequate vaginal length and dealing with a high insertion of the vagina into the proximal urethra. The Paserrini vaginoplasty is a relatively new approach to this problem. It which allows one to utilize the child's own preputial tissues to form a natural and capacious vaginal cavity via the perineal approach.
The child in the video was diagnosed at birth with ambiguous genitalia, and congenital adrenal hyperplasia. A preoperative genitor-vaginogram demonstrated a high insertion of her vagina into the urethra just below the bladder neck. Because of this severe degree of virilization, a Paserrini procedure was selected. At six months of age, she was taken to surgery.
The key portions of the procedure are: 1) Placement of Fogarty catheters into the vagina and Foley into the bladder; 2) creation of an inverted 'Y' incision centralized where the vagina will be located; 3) Detachment of the vagina from the urethra; 4) Formation of Byer's flaps and creation of the distal neo-vagina: 5) Clitorrhal recession; and 6) suturing the neo-vagina to the proximal vagina, and skin closure.