Posterior sagittal transanorectal approach in patients with ambiguous genitalia: report of eight cases.

The posterior sagittal transanorectal approach was used for reconstruction of the female genitalia (vaginoplasty) in eight girls with urogenital sinus, high vaginal implantation, and normal rectum, in all cases with a protective sigmoidostomy. These eight patients included four female and four male pseudohermaphrodites. They remain fecally continent, but only seven have urinary continence. One girl has a neuropathic bladder: umbilical discomfort during abdominal straining is present in one patient. One girl married and demonstrated satisfactory sexual intercourse. All patients are alive and healthy, physically and mentally. The transanorectal approach allows separation of the vagina from the urethra and bladder, provides good vaginal mobilization down to the perineum, avoids the utilization of perineal skin flaps and sometimes a laparotomy, and preserves defecation and urinary control. The cosmetic appearance of the genitalia seems to be better than that achieved in the past with other techniques.