Nerve sparing ventral clitoroplasty preserves dorsal nerves in congenital adrenal hyperplasia. Academic Article uri icon

Overview

abstract

  • PURPOSE: Masculinization of the female genitalia observed in patients with classic congenital adrenal hyperplasia often results in clitorimegaly. Reduction clitoroplasty is the most widely practiced corrective surgery for clitorimegaly, yet reservations about surgical intervention exist based on fears of nerve destruction during surgical removal of excess erectile tissue. In this study, we modified the reduction clitoroplasty and examined excised erectile tissue for the presence of dorsal nerves. MATERIALS AND METHODS: We describe the development of the nerve sparing ventral clitoroplasty. Nerves were examined in situ using optical coherence technology. In addition, erectile tissue removed from 27 female patients with congenital adrenal hyperplasia was examined immunohistochemically for the presence of nerves by staining for neurofilament. Nerves outside of the tunica albuginea were counted and measured. Tissue from 2 adult females was also examined by immunohistochemistry. RESULTS: Optical coherence technology visualized dorsal nerves in 3 patients with congenital adrenal hyperplasia (size 600 to 800 microm). In 4 of 27 patients undergoing nerve sparing ventral clitoroplasty, no dorsal nerve branches were visualized in excised erectile tissue. In another 18 patients 10 or fewer nerve branches were found. In patients who underwent nerve sparing ventral clitoroplasty 92% of dorsal nerves detected were 90 microm or less. In contrast, 88% of dorsal nerves found in the 2 adult specimens were 120 microm or greater. The maximum nerve fiber size observed in patient specimens was significantly smaller than the maximum nerve fiber size observed in control specimens. CONCLUSIONS: Scarcity of large dorsal nerves in histological specimens excised using nerve sparing ventral clitoroplasty likely reflects their preservation within the congenital adrenal hyperplasia patients. This preservation is vital to future somatosensory and motor function of the clitoris.

publication date

  • August 17, 2007

Research

keywords

  • Adrenal Hyperplasia, Congenital
  • Clitoris

Identity

Scopus Document Identifier

  • 34548410897

Digital Object Identifier (DOI)

  • 10.1016/j.juro.2007.03.186

PubMed ID

  • 17707008

Additional Document Info

volume

  • 178

issue

  • 4 Pt 2