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CONGRESS OF THE ESPU
VS-32 (VS without presentation)
PULL-THROUGH VAGINOPLASTY FOR HIGH CONFLUENCE
UROGENITAL SINUS (UGS) IN A GIRL WITH CONGENITAL
ADRENAL HYPERPLASIA (CAH)
Rafael GOSALBEZ, Paulo MOSCARDI and Abd-El-Rahman ABD-EL-BARR
Nicklaus Children's Hospital - University of Miami, Pediatric Urology, Miami, USA
INTRO AND OBJECTIVES
Our patient is an 18-month-old girl born full-term with ambiguous genitalia and a salt-wasting form
of CAH. We present a pull-through vaginoplasty for a high confluence UGS.
METHODS
The patient is positioned in a prone jack knife position and UGS endoscopy is performed with the
objective to evaluate the urethra and the vagina. Two foley catheters are positioned: one in the
bladder and other in the vagina, to facilitate further dissection.
A perineal midline incision extended in a Y shape around the anal verge is made. The UGS is
exposed separating the bulbospongiosus muscle and exposing the anterior vaginal wall from the
posterior rectal wall reaching the peritoneal fold at the level of the cervix and the uterus proximally.
A longitudinal incision of the UGS at 12 o'clock is extended proximally until the confluence is identi-
fied. The fully mobilized vagina is advanced towards the perineum, and the anterior vaginal wall is
fixed to the urethral ventral margin.The posterior vaginal fourchette is then fashioned demarcating
the length of the perineum. The labia majora are advanced to the vaginal introitus and the rest of
the perineum is closed. Advancing the lateral vaginal walls to the perineum completes the repair.
RESULTS
The patient had an uneventful post-operative course with a good cosmetic outcome at the follow-up.
CONCLUSIONS
CAH can often present with high confluence UGS. In such cases, our preferred approach is a pull
through vaginoplasty, after separating the vagina from the urogenital sinus. This technique can
provide good functional and cosmetics outcomes.
VS-33 (VS without presentation)
ZERO ISCHAEMIA OPEN PARTIAL THULIUM LASER
NEPHRECTOMY IN PAEDIATRIC RENAL TUMOR:
FIRST EXPERIENCE
Angling YUNANTO, Agus RIZAL, Irfan WAHYUDI and Arry RODJANI
Cipto Mangunkusumo Hospital, Department of Urology, Jakarta, INDONESIA
INTRODUCTION AND OBJECTIVES
Thulium laser presents a promising alternative to achieve tumor excision and renal hemostasis
without hilar occlusion thus it preserves renal function. Its use in paediatrics partial nephrectomy
has not been significantly evaluated. We report a case of pT1N0M0 papillary renal cell carcinoma
at inferior pole of the left kidney in 10 year-old female patient treated by zero ischaemia open partial
Thulium laser nephrectomy. This study aims to know the effectivity and efficacy of Thulium laser in
open partial nephrectomy especially in paediatrics.
MATERIAL AND METHODS
We used the Thulium laser (RevoLix DUO) with power 30 - 50 Watt and Cavitron Ultrasonic Surgical
Aspirator/CUSA (SONOCA 300) in frequency 25 kHz to excise the tumor and control the bleeding.