Successful Surgical Correction of Congenital Colonic Duplication and Anogenital Cleft in a Cat.

A 17 wk old sexually intact female domestic shorthair kitten presented for an anogenital cleft and enlarged colon. The cat had experienced bacterial cystitis and constipation since weaning. Contrast referral images revealed an enlarged colon with a patent anus. Clinical examination revealed an anogenital cleft with a common anovulvar orifice. The rectum was patent upon digital rectal palpation, and fecal contamination of the vulva was present. Abdominal radiographs revealed two distinct colons, both filled with a moderate amount of formed fecal material. Contrast-enhanced computed tomography revealed segmental duplication of the descending colon with a dominant right colon and a smaller accessary left colon. The two structures conjoined at the transverse colon proximally and at the pubic brim distally. A common anogenital orifice with anovulvar communication was also noted. The anogenital cleft malformation was successfully repaired surgically. A celiotomy was performed to remove the smaller accessory colon. An ovariectomy and partial hysterectomy were also performed. The patient recovered uneventfully and showed no gross evidence of recurrent cystitis or urinary or fecal incontinence postoperatively. This is believed to be the first report of a congenital anogenital cleft and complete communicating colonic duplication in a cat.

Developmental and family history-based analysis of congenital fused labia phenotype in the captive common marmoset (Callithrix jacchus).

BACKGROUND: Congenital fused labia (CFL) is defined as a failure or significant delay in the opening of the juvenile sealed labia majora. This phenotype is known to be variably common in adult captive female marmosets but has never been investigated in detail before. MATERIALS AND METHODS: Here, we define, describe and quantify the variations in the degree of closure of the vulva in 122 captive marmosets (Callithrix jacchus) from 1.2 to 42 months old and include colony analysis. RESULTS: There was a negative correlation between the degree of labial fusion and animal age after prepubertal period (P < 0.05). CFL females had higher number CFL relatives (4.3 ± 0.6 vs 2.4 ± 0.5 for non-CFL, P < 0.05) and more external ancestors compared to non-CFL (P < 0.05). CONCLUSIONS: Our results therefore suggest that CFL phenotype is most likely associated with epigenetic effects induced by the captive environment and colony management strategy of extensive crossing of family lines to promote heterozygosity.

[Feminizing genitoplasty in virilization of the external genitalia].

The review focuses on the feminizing genitoplasty of the external genitalia in patients with disorders of sex development. The opinions of various surgeons and surgical schools on the timing, stages and methods of performing feminizing genitoplasty in girls with the virilization of the genitalia are presented. The development and improvement of surgical techniques for performing clitoroloplasty in patients with virilization of genitalia are described, as well as different types of labioplasty. The main methods of reconstruction of the urogenital sinus are given.

Unilateral hypertrophy of the labia minora: A case series.

Asymmetric hypertrophy of the labia minora is a variant of normal anatomy that has not been described in the pediatric dermatology literature. Although often asymptomatic, in some cases, it can cause functional, emotional, and psychological problems. We report the clinical characteristics and outcomes of four children who presented with unilateral labium minus hypertrophy. This case series aims to establish awareness of this condition among pediatric dermatologists and provide recommendations regarding management.

The SWI/SNF chromatin remodeling complex exerts both negative and positive control over LET-23/EGFR-dependent vulval induction in Caenorhabditis elegans.

Signaling by the epidermal growth factor receptor (EGFR) generates diverse developmental patterns. This requires precise control over the location and intensity of signaling. Elucidation of these regulatory mechanisms is important for understanding development and disease pathogenesis. In Caenorhabditis elegans, LIN-3/EGF induces vulval formation in the mid-body, which requires LET-23/EGFR activation only in P6.p, the vulval progenitor nearest the LIN-3 source. To identify mechanisms regulating this signaling pattern, we screened for mutations that cooperate with a let-23 gain-of-function allele to cause ectopic vulval induction. Here, we describe a dominant gain-of-function mutation in swsn-4, a component of SWI/SNF chromatin remodeling complexes. Loss-of-function mutations in multiple SWI/SNF components reveal that weak reduction in SWI/SNF activity causes ectopic vulval induction, while stronger reduction prevents adoption of vulval fates, a phenomenon also observed with increasing loss of LET-23 activity. High levels of LET-23 expression in P6.p are thought to locally sequester LIN-3, thereby preventing ectopic vulval induction, with slight reductions in its expression interfering with LIN-3 sequestration, but not vulval fate signaling. We find that SWI/SNF positively regulates LET-23 expression in P6.p descendants, providing an explanation for the similarities between let-23 and SWI/SNF mutant phenotypes. However, SWI/SNF regulation of LET-23 expression is cell-specific, with SWI/SNF repressing its expression in the ALA neuron. The swsn-4 gain-of-function mutation affects the PTH domain, and provides the first evidence that its auto-inhibitory function in yeast Sth1p is conserved in metazoan chromatin remodelers. Finally, our work supports broad use of SWI/SNF in regulating EGFR signaling during development, and suggests that dominant SWI/SNF mutations in certain human congenital anomaly syndromes may be gain-of-functions.

[Postoperative complications of labia minora reduction. Comparative study between wedge and edge resection]. / Complications postopératoires des nymphoplasties de réduction. Étude comparative rétrospective entre résections longitudinale et cunéiforme.

BACKGROUND: Labia minora reduction interventions rise in Europe and in North America. Several techniques are described. The objective of this study was to compare postoperative complications of the two most practiced interventions: wedge resection and edge resection. METHODS: Primary labia minora reductions realized in our unit between October 2009 and July 2016 have been retrospectively identified. Two techniques were used by two surgeons: edge resection technique and wedge resection technique. The main evaluation criterion was the occurrence and the quantity of wound dehiscence: superior to 50% (total or subtotal) and inferior to 50% (partial). Patients were systematically examined at 1 week, 1 month and 6 months postoperatively. Data analysis between both groups was made with an exact Fisher test. RESULTS: Mean follow-up was 5.3 months after intervention. Sixty-four patients have been included, 42 wedge resections (group C) and 22 edge resections (group L). Global complication rate at 1 month was 13% (n=8). Among wedge resections 14% (n=6) developed complication and 2% (n=9) among edge resection. Seven surgical revisions were necessary: 5 for wound dehiscence (4 in the group C and 1 in the group L) and 2 for hematoma, one in each group. Three (5%) partial wound dehiscence (inferior to 50%) have been identified and let in secondary intention healing: 2 (19%) in the group C and 1 (27%) in the group L. Complication rates between both techniques were not significantly different. CONCLUSIONS: Postoperative wound dehiscence is the main labia minora reduction complication. Our global complication rate, 13%, matches with the current literature. A tendency can be shown where wedge resection is more likely to develop wound dehiscence than edge resection.

Aesthetic Labia Minora Reduction with Combined Wedge-edge Resection: A Modified Approach of Labiaplasty.

BACKGROUND: Nowadays, the demand for female genital rejuvenation procedures especially for labiaplasty is surging. Labia minora reduction has been the most practiced esthetic procedure for the female genitalia in China. Gynecological plastic surgeons have proposed several methods for labia reduction, but there is no consensus on which one is the best choice. Patients often receive re-operations for inadequate resection and asymmetry with existing methods. Here we present a modified method of labiaplasty combined wedge and edge resection and to discuss the appropriate indications of this method. METHODS: From January 2009 to March 2014, we performed 524 labia esthetic surgeries. The methods we used mainly include simple edge resection, wedge resection, modified de-epithelialization, and the combined method discussed in this article. Forty-nine patients aged from 25 to 45 years were selected to receive combined wedge-edge labial resection and were retrospectively reviewed. Patients were required to come back for follow-up assessment at 1 and 6 months. RESULTS: Twenty-one of forty-nine (42.9 %) patients underwent unilateral labial reduction. The average time for the procedures was 56 min. The mean follow-up was 4.5 months. All the surgeries were successfully performed and 47 patients experienced an uneventful postoperative period. A minor dehiscence occurred in two patients. One of the patients received a revision surgery correcting a postoperative asymmetry malformation. Finally, all the patients were satisfied with the esthetic appearance. CONCLUSION: The combined wedge-edge reduction of the labia minora is a simple and safe method associated with high satisfaction and a low complication rate. Therefore, we propose this combined procedure for bi-dimensional and/or unilateral hypertrophied labia minora especially in those who require removal of the dark margin of the labia.

Labia minora reduction techniques: a comprehensive literature review.

BACKGROUND: Many studies of techniques to reduce the labia minora have been published in recent decades, including case reports and retrospective case series. However, to date, there has been no study of the overall complications or satisfaction rates associated with the broad spectrum of techniques. OBJECTIVES: The authors performed a comprehensive literature review to determine outcomes and complications of labiaplasty techniques, including patient satisfaction. METHODS: A search on PubMed/Medline was performed with the keywords labiaplasty, labioplasty, labial hypertrophy, and techniques plus labia minora reduction. The inclusion criterion was clinical studies in which techniques of labia minora reduction were described. Excluded from the study were publications not dealing with surgical procedures and review articles. RESULTS: Thirty-eight studies, published from 1971 through 2014, were included; this represented 1981 treated patients. Eight labiaplasty techniques were identified from these studies: edge resection, wedge resection, deepithelialization, W-plasty, laser labiaplasty, custom flask, fenestration, and composite reduction. Satisfactory results, judged from clinical examination, were observed with all 8 techniques. Few postoperative complications occurred. In a small number of cases, complications required surgical revision or secondary resection. CONCLUSIONS: All 8 labiaplasty techniques resulted in good outcomes, including high patient satisfaction and low morbidity.

Aesthetic surgery of female external genitalia.

Aesthetic surgery of the external genitalia in women encompasses many procedures and may address the labia minora, clitoral hood, labia majora, mons pubis, or vaginal opening. During the initial evaluation, the surgeon should consider all aspects of the external genitalia to develop an appropriate surgical plan. It may be necessary to perform 2 or more procedures during the same surgical session to achieve the desired aesthetic result. In this continuing medical education (CME) article, we review the literature and summarize the available cosmetic techniques for female external genitalia. Resection of the labia minora has been described in several peer-reviewed reports. We also discuss the procedures and modifications to direct resection, wedge resection, and deepithelialization of the labia minora. Aesthetic surgery of the clitoral hood may involve straight-line resection, extended wedge resection, or inverted V hoodoplasty. The mons pubis may be treated with mons pubis pexy, wedge resection, or lipomodeling. The labia majora can be managed with direct resection or lipomodeling, and hymenoplasty may be performed to correct a wide vaginal opening.

[Pediatric gynecological operations based on 40 years' experience]. / Gyermek-nogyógyászati mutétek 40 év tapasztalatai alapján.

The author analyzes more than 40 years of his own experience concerning the outcome of pediatric gynecology patients who underwent surgery in the Department of Gynecology and Obstetrics, Debrecen University in Hungary. Traditional surgical interventions were performed, and, some new methods elaborated by the author. The age of patients who underwent surgery ranged from infancy to 18 years. The objective of this publication is to describe general principles to support the work of those who are currently active in this area or have chosen the area for their future activity. Types of surgical interventions, conditions of proper management and insitutional background, together with requirements of qualified personnel and diagnostic performance are analyzed. Possible sources of errors and their prevention are pointed out. Different procedures are discussed in separate groups. The author's own procedure modifications based on the original procedure elaborated by Vecchietti for treatment of vaginal aplasia are described. Concluding from results of more than 60 successful modified Vecchietti procedures the author recommends his own procedure.

[Perineal groove in pediatric gynecology: a report of 2 cases]. / Surco perineal en ginecología infantil: reporte de 2 casos clínicos.

INTRODUCTION: the perineal groove is a very uncommon anorectal anomaly. It is the result of an unknown embryology anomaly. The perineal groove is a wet sulcus extending from de fourchette to the anus. It is a benign pathology and tends to resolve spontaneously. OBJECTIVE: We report two cases of girls diagnosed with perineal groove and their follow up. CASES REPORTS: The first case is an 18 days old baby girl, that during her first clinical examination there was found a painless lineal lesion in the perineum from the fourchette to the anus, which created a big anxiety in her family. She was cared at the Pediatric Gynecology Unit, with local lubrication, doing well with the epithelization of it. The second case is an 8 year-old girl who consulted because, when being a child, she was diagnosed with a perineal lesion, but she didn't receive any special treatment and now she feels some aches in the perineum. CONCLUSIONS: The perineal groove is a benign entity pretty unknown by general practitioners or pediatricians. It is important to be up to date with this condition to avoid alarming misinterpretations.

Constricted posterior fourchette deformities: Definition, classification and surgical treatment.

BACKGROUND: Labiaplasty is one of the top cosmetic procedures patients are seeking in the past two years. However, treatment of disease in posterior fourchette caused by various etiological factors was less investigated and neglected. METHODS: Three types of posterior fourchette deformity were proposed: (1) Redundant posterior fourchette, (2) Relaxed posterior fourchette, and (3) Constricted posterior fourchette. Local flap transfer technique was applied. Y-V-plasty and 5-Z-Flap-plasty were used to treat web type and tight type of the constricted posterior fourchette, respectively. Follow-ups were arranged on the Internet or at the outpatient clinic. Visual analogue scale (VAS) was utilized to evaluate sexual discomfort in the satisfaction questionnaires during follow-up. RESULTS: A total of 48 patients with constricted posterior fourchette deformity from May 2022 to May 2023 were reviewed in the study. Y-V-plasty could decrease VAS in patients with web-type deformity by 4.13 ± 1.46 (p＜0.001). 5-Z-Flap-plasty could decrease VAS in patients with tight-type deformity by 3.76 ± 1.53 (p＜0.05). Satisfaction rates of the web type and tight type were 93.1% (27/29) and 86.7% (13/15) respectively. Complications include two cases of hematoma, one case of persistent pain and two cases of dehiscence. CONCLUSION: Constricted posterior fourchette seriously affects the quality of life. Y-V-plasty and 5-Z-Flap-plasty can be utilized to treat the two subtypes of constricted posterior fourchette, which can effectively reduce the pain score of patients with high satisfaction and few long-term complications.

Fetal transient clitoromegaly and transient hypertrophy of the labia minora in early and mid pregnancy.

OBJECTIVE: The purpose of this study was to describe a series of cases of transient changes in the female fetal external genitalia. METHODS: In our practice area, most pregnant women usually undergo a detailed sonographic survey of all fetal organs, including the external genitalia in early and mid pregnancy. RESULTS: During the study period (1987-2010), 62,145 consecutive pregnant women were scanned. We detected 4 fetuses with an isolated finding of clitoromegaly at 15 to 16 weeks' gestation, which disappeared at 22 to 26 weeks. Maternal hormonal study results were normal. There was 1 case of clitoromegaly and a cloacal anomaly at 15 weeks' gestation, in which the clitoris retuned to a normal size at 22 weeks. In addition, there were 3 cases of hypertrophy of the labia minora in early pregnancy, which disappeared at 26 to 32 weeks. All fetuses in these series had a normal XX karyotype and normal external genitalia at birth. CONCLUSIONS: Transient changes in the appearance of the fetal external genitalia may occur in chromosomally normal female fetuses.

Female pseudo-hermaphroditism with cloacal malformation and related anomalies in a dog.

A 7-month-old intact female German shepherd dog was presented with recurrent urinary tract infections and incontinence, ambiguous external genitalia (enlarged vulva containing a penis), and an anovestibular fistula. Anatomical structures, histopathology, and karyotyping supported a diagnosis of female pseudo-hermaphrodite, hypothesized to be a result of in utero androgenization with consequential cloacal malformation.

Pseudo-hermaphroditisme femelle avec une malformation cloacale et des anomalies connexes chez un chien. Une chienne Berger allemand intacte âgée de 7 mois a été présentée pour des infections urinaires à répétition et de l'incontinence, des organes génitaux externes ambigus (vulve agrandie contenant un pénis) et une fistule ano-vestibulaire. Les structures anatomiques, l'histopathologie et le caryotypage ont soutenu le diagnostic d'une pseudo-hermaphrodite femelle, présentant l'hypothèse d'avoir été provoquée par une androgénisation in utero avec une malformation cloacale correspondante.(Traduit par Isabelle Vallières).

A case report of spontaneous opening of congenitally fused labia in a female common marmoset (Callithrix jacchus) followed by pregnancy and birth of twins.

A first case of spontaneous opening of congenitally fused labia (CFL phenotype) in a captive common marmoset followed by pregnancy and birth is presented here. The occurrence of this phenotype has been previously published in captive marmosets, but so far the etiology is unknown.

Female external genitalia on fetal magnetic resonance imaging.

OBJECTIVES: To characterize the normal development of the female external genitalia on fetal magnetic resonance imaging (MRI). METHODS: This retrospective study included MRI examinations of 191 female fetuses (20-36 gestational weeks) with normal anatomy or minor abnormalities, following suspicion of anomalies on prenatal ultrasound examination. Using a 1.5-Tesla unit, the bilabial diameter was measured on T2-weighted sequences. Statistical description, as well as correlation and regression analyses, was used to evaluate bilabial diameter in relation to gestational age. MRI measurements were compared with published ultrasound data. The morphological appearance and signal intensities of the external genitalia were also assessed. RESULTS: Mean bilabial diameters, with 95% CIs and percentiles, were defined. The bilabial diameter as a function of gestational age was expressed by the regression equation: bilabial diameter = - 11.336 + 0.836 × (gestational age in weeks). The correlation coefficient, r = 0.782, was statistically significant (P < 0.001). Bilabial diameter on MRI was not significantly different from that on ultrasound (P < 0.001). In addition, on MRI we observed changes in morphology of the external genitalia and in signal intensities with increasing gestational age. CONCLUSIONS: We have provided a reference range of fetal bilabial diameter on MRI, which, in addition to ultrasound findings, may be helpful in the identification of genital anomalies.

Labial fusion causing urinary incontinence and recurrent urinary tract infection in a postmenopausal female: a case report.

A 73-year-old postmenopausal woman was admitted with recurrent urinary tract infection and a history of incontinence. General physical examination was normal. Complete labial fusion was noticed on genital examination. Surgical intervention was performed. This therapy alleviated incontinence and recurrent urinary tract infection.

Differential Diagnosis of a Unique Vulvar Mass in an Adolescent.

BACKGROUND: Vulvar masses in adolescents have a broad differential diagnosis, yet few reports exist detailing masses of mammary origin. CASE: A nulliparous, healthy 16-year-old adolescent presented with a longstanding, ulcerated, 17-cm vulvar mass of unknown origin and pronounced inguinal lymphadenopathy. The patient underwent a left radical partial vulvectomy, with pathology revealing terminal duct lobular units consistent with polymastia. CONCLUSION: Differential diagnosis of a vulvar mass in an adolescent should include polymastia.