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Serous Lined Extramural Tunnel Principle in the Creation of a Catheterizable Channel in Bladder
ESPU Programme 2010
S91
# S18-13 (O) GENDER ROLE BEHAVIOUR, SEXUALITY AND SEXUAL FUNCTION IN WOMEN WITH CONGENITAL ADRENAL HYPERPLASIA ¨ LD1, Anna NORDENSTROM2, Louise FRISEN3, Henrik FALHAMMAR4, Helena FILIPSSON5, Agneta NORDENSKJO Gundela HOLMDAHL6, Peo JANSSON7, Marja THOREN4 and Kerstin HAGENFELDT8 1
Pediatric Surgery, Women and Children Health, Stockholm, SWEDEN, 2Pediatrics, Clintec, Karolinska Institutet, Stockholm, SWEDEN, Psychiatry, Clinical Sciences, Karolinska institutet, Stockholm, SWEDEN, 4Endocrinology, Metabolism and Diabetes, Molecular Medicine and Surgery, Stockholm, SWEDEN, 5Endocrinology, Sahlgrenska Academy of Gothenburg University, Gothenburg, SWEDEN, 6Pediatric Surgery, Queen Silvia Children Hospital, Gothenburg, SWEDEN, 7Obstetrics and Gynecology, Sahlgrenska Academy of Gothenburg University, Gothenburg, SWEDEN, 8Obstetrics and Gynecology, Women and Children Health, Stockholm, SWEDEN 3
PURPOSE Females with congenital adrenal hyperplasia (CAH) are exposed to androgens during fetal development resulting in virilization of external genitalia. Gender-atypical behavior has been described in young girls with CAH. Little is known about what effect the disease has on their lives.
MATERIAL AND METHODS Sixty-two Swedish women with CAH and agematched controls completed a 120-item questionnaire, McCoy sexual rating scale and a validated quality of life instrument (PGWB). Surgical outcome was evaluated by
clinical examination. The patients were divided into four genotype groups.
lower for sexual function and satisfaction and had more surgical complications.
RESULTS
CONCLUSIONS
Cases held more male-dominant occupations (30%) compared to controls (13%) (P¼0.04), especially women with null mutations. They also reported a greater interest in rough sports (74%) compared to controls (50%) (P¼0.007). Eight women with CAH (14%) reported a prime interest in motor vehicles, compared to none of the controls (P¼0.002). Non-heterosexual orientation was reported by 19% of women with CAH (P¼0.005), 50% of those with null mutations (P¼0.0001). The patients in the null genotype group scored
Women with CAH display an increased gender-atypical behavior that is correlated to the genotype. This speaks in favor of dose dependent effects of prenatal androgens on the development of higher brain functions. The impact of the disease on upbringing and interpersonal relationships did not correlate with disease severity. Our data also shows that the null genotype group was considerably more affected than the other groups and should be regarded as a subgroup with special needs.
V: VIDEO ROOM
# V-1 (V) SEROUS LINED EXTRAMURAL TUNNEL PRINCIPLE IN THE CREATION OF A CATHETERIZABLE CHANNEL IN BLADDER Waleed EASSA, Roman JEDNAK, John Paul CAPOLICCHIO and Mohamed EL SHERBINY McGill University Health Center, Pediatric Urology, Montreal, CANADA
PURPOSE To evaluate the versatility of this principle and its aptness to various situations in pediatric reconstructive surgery providing a video showing the fine technical details.
MATERIAL AND METHODS Over the past 9 years, the principle was used in 11 patients (mean age 11years). Indications were: 2 conversions from ileal conduit to continent cutaneous (1 PUV, 1 pelvic rhabdomyosarcoma) and 9 creations of catheterizable channel in bladder augmentation (1 PUV, 3 spina bifida, 5 bladder-exstrophy). Associated procedures
were (1 BN closure, 2Sling, 5 Mitchell BNR, 2 MACE). Appendix was used as an outlet in 7 and Monti in 4.
(mean follow up of 2.4years postoperatively).
CONCLUSIONS RESULTS In all, the stoma was successfully matured to the umbilicus. There were no postoperative complications or difficult catheterization. In the first 3months all were continent. Three-6months later, 3/ 11(27%) developed secondary incontinence (Injection was tried unsuccessfully). Surgical revisions showed de-ssusception of the tunnel in each (each had Monti outlet). Eight/11(73%) remained continent
This technique is versatile. Can be used as primary or salvage surgery. The stoma can always be brought to the umbilicus. The appendix is the preferred continent outlet. Fine surgical details as fixation of the outer pouch wall of the tunnel to the inner anterior abdominal wall and the use of interrupted non-absorbable sutures in the tunnel floor are crucial for the success. One disadvantage is that bulking agent injection is not useful to treat secondary incontinence.
S91
# S18-13 (O) GENDER ROLE BEHAVIOUR, SEXUALITY AND SEXUAL FUNCTION IN WOMEN WITH CONGENITAL ADRENAL HYPERPLASIA ¨ LD1, Anna NORDENSTROM2, Louise FRISEN3, Henrik FALHAMMAR4, Helena FILIPSSON5, Agneta NORDENSKJO Gundela HOLMDAHL6, Peo JANSSON7, Marja THOREN4 and Kerstin HAGENFELDT8 1
Pediatric Surgery, Women and Children Health, Stockholm, SWEDEN, 2Pediatrics, Clintec, Karolinska Institutet, Stockholm, SWEDEN, Psychiatry, Clinical Sciences, Karolinska institutet, Stockholm, SWEDEN, 4Endocrinology, Metabolism and Diabetes, Molecular Medicine and Surgery, Stockholm, SWEDEN, 5Endocrinology, Sahlgrenska Academy of Gothenburg University, Gothenburg, SWEDEN, 6Pediatric Surgery, Queen Silvia Children Hospital, Gothenburg, SWEDEN, 7Obstetrics and Gynecology, Sahlgrenska Academy of Gothenburg University, Gothenburg, SWEDEN, 8Obstetrics and Gynecology, Women and Children Health, Stockholm, SWEDEN 3
PURPOSE Females with congenital adrenal hyperplasia (CAH) are exposed to androgens during fetal development resulting in virilization of external genitalia. Gender-atypical behavior has been described in young girls with CAH. Little is known about what effect the disease has on their lives.
MATERIAL AND METHODS Sixty-two Swedish women with CAH and agematched controls completed a 120-item questionnaire, McCoy sexual rating scale and a validated quality of life instrument (PGWB). Surgical outcome was evaluated by
clinical examination. The patients were divided into four genotype groups.
lower for sexual function and satisfaction and had more surgical complications.
RESULTS
CONCLUSIONS
Cases held more male-dominant occupations (30%) compared to controls (13%) (P¼0.04), especially women with null mutations. They also reported a greater interest in rough sports (74%) compared to controls (50%) (P¼0.007). Eight women with CAH (14%) reported a prime interest in motor vehicles, compared to none of the controls (P¼0.002). Non-heterosexual orientation was reported by 19% of women with CAH (P¼0.005), 50% of those with null mutations (P¼0.0001). The patients in the null genotype group scored
Women with CAH display an increased gender-atypical behavior that is correlated to the genotype. This speaks in favor of dose dependent effects of prenatal androgens on the development of higher brain functions. The impact of the disease on upbringing and interpersonal relationships did not correlate with disease severity. Our data also shows that the null genotype group was considerably more affected than the other groups and should be regarded as a subgroup with special needs.
V: VIDEO ROOM
# V-1 (V) SEROUS LINED EXTRAMURAL TUNNEL PRINCIPLE IN THE CREATION OF A CATHETERIZABLE CHANNEL IN BLADDER Waleed EASSA, Roman JEDNAK, John Paul CAPOLICCHIO and Mohamed EL SHERBINY McGill University Health Center, Pediatric Urology, Montreal, CANADA
PURPOSE To evaluate the versatility of this principle and its aptness to various situations in pediatric reconstructive surgery providing a video showing the fine technical details.
MATERIAL AND METHODS Over the past 9 years, the principle was used in 11 patients (mean age 11years). Indications were: 2 conversions from ileal conduit to continent cutaneous (1 PUV, 1 pelvic rhabdomyosarcoma) and 9 creations of catheterizable channel in bladder augmentation (1 PUV, 3 spina bifida, 5 bladder-exstrophy). Associated procedures
were (1 BN closure, 2Sling, 5 Mitchell BNR, 2 MACE). Appendix was used as an outlet in 7 and Monti in 4.
(mean follow up of 2.4years postoperatively).
CONCLUSIONS RESULTS In all, the stoma was successfully matured to the umbilicus. There were no postoperative complications or difficult catheterization. In the first 3months all were continent. Three-6months later, 3/ 11(27%) developed secondary incontinence (Injection was tried unsuccessfully). Surgical revisions showed de-ssusception of the tunnel in each (each had Monti outlet). Eight/11(73%) remained continent
This technique is versatile. Can be used as primary or salvage surgery. The stoma can always be brought to the umbilicus. The appendix is the preferred continent outlet. Fine surgical details as fixation of the outer pouch wall of the tunnel to the inner anterior abdominal wall and the use of interrupted non-absorbable sutures in the tunnel floor are crucial for the success. One disadvantage is that bulking agent injection is not useful to treat secondary incontinence.