Use of Vaginoscopy after Vaginoplasty in Individuals with Congenital Adrenal Hyperplasia

Study Objective

To explore the use of exam under anesthesia with vaginoscopy (EUA-V) after vaginoplasty in patients with congenital adrenal hyperplasia (CAH)

Design

Retrospective cohort

Methods

An institutional review board-approved retrospective chart review was performed of the postsurgical follow-up care of all patients diagnosed with classic CAH who sought care at a tertiary children's hospital from 2000 to 2017 and had undergone vaginoplasty at that institution.

Results

Twenty-six patients met the inclusion criteria. The median age at vaginoplasty was 1.25 years (IQR 0.67-9). The median postsurgical follow-up was 5.5 years (IQR 1.5-9). Twenty-six EUA-Vs were performed, on 22 patients. Four were for complication assessment (rectovaginal fistula¹ and urethrovaginal fistula³—on the same patient). The remaining 22 EUA-Vs, performed on 20 patients with 2 each undergoing 2 EUA-Vs, were planned for routine evaluation of vaginal patency. They were done a median of 0.67 years (IQR 0.25-2) after surgery and at a median of 6.67 years of age (IQR 1.75-12). Of these, 5 EUA-Vs identified stenosis in 5 patients (25%), a median of 0.91 years (IQR 0.5-7) after surgery, at a median age of 8.42 years (IQR 2-10.92). Of the 4 who did not undergo EUA-V, 1 had stenosis on clinical exam with ultrasound-verified hematocolpos. The remaining 3 were all prepubertal at last follow-up.

Conclusion

Most CAH patients after vaginoplasty underwent routine EUA-V, roughly a quarter of which detected stenosis. EUA-Vs may play a beneficial role in routine postoperative care after vaginoplasty in patients with CAH.