For most patients with the common form of this syndrome, low insertion of the vagina is present and surgical correction involves perineal vaginoplasty and/or clitoral recession. Every effort is made to preserve the neurovascular bundle in order to preserve vascular-ity and sensation. The procedure involves degloving of the enlarged clitoris and dissecting the erectile tissue to the bifurcation. Plication sutures are placed laterally and the tissue is folded under the pubis while the sutures are tied. In cases where the phallus is so large that reduction clitoroplasty is not possible (a rare event), the corporal bodies can be resected with preservation of the glans and neurovascular bundle.
A large glans can be reduced by resecting a wedge of the ventral tissue and closing the skin edges. The vaginoplasty for low urogenital sinus abnormalities is illustrated in Fig. 35.2 and is performed by using a U- or Y-shaped incision posterior to the opening. The vagina is mobilized if necessary with traction sutures and the posterior anastomosis is performed with interrupted absorbable sutures.
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