Is Total Urogenital Mobilization Safe and Continent-Preserving Across a Wide Age Range in Congenital Adrenal Hyperplasia? A Single-Center Experience of 73 Patients.

BACKGROUND

Despite widespread adoption of total urogenital mobilization (TUM) for feminizing genitoplasty in congenital adrenal hyperplasia (CAH), quantitative intraoperative benchmarks remain unreported in the literature, and urinary continence outcomes in CAH remain incompletely established.

PURPOSE: To document urinary continence, complication rate and other operative parameters of TUM performed exclusively for CAH in a consecutive single-center cohort.

METHODS

73 consecutive 46,XX CAH patients (Prader III, n=45; Prader IV, n=28), aged 2 to 168 months, underwent TUM at a single institution between January 2014 and March 2025. Operative time, estimated blood loss, complications, and urinary continence, assessed clinically and urodynamically, were analyzed. Spearman correlation assessed the relationship between common channel length and intraoperative parameters.

RESULTS

Urinary continence, supported by clinical and urodynamic findings, was preserved in all 52 toilet-trained patients (100%). No complication attributable to the surgical technique occurred over 4 years median follow-up; 11 patients (15.1%) developed catheter-related Grade I urinary tract infection, all resolving fully. Median operative time was 145 minutes (IQR 120-178) and median estimated blood loss was 16 mL (IQR 12-19); no patient required perioperative transfusion. Common channel length correlated strongly with operative time (r=0.83, p<0.001) but not with estimated blood loss (r=0.23, p=0.09). Four patients with common channel length exceeding 6.5 cm required distal urethral plate augmentation without bladder neck involvement.

CONCLUSIONS

TUM demonstrates a favorable perioperative and postoperative safety profile in CAH, with hemostatic stability independent of anatomical complexity. TUM safely preserves continence even in older children and anatomically complex cases with appropriate technical modification.