Patent RU-2752033-C2 (RU)
Title: Method for feminizing plastic surgery and separation of urinary and genital tracts in high urethro-vaginal fusion in infants with congenital dysfunction of adrenal cortex
Inventor: DEDOV IVAN IVANOVICH
IPC: A61B17/42
Filed: 2020-10-26
Granted: 2021-07-22
Abstract: FIELD: medicine, gynecology in particular. 
     SUBSTANCE: invention relates to medicine, namely to operative gynecology. If the length of the common genitourinary canal, the nephrogonoduct, is equal to or greater than 28 mm, then when forming an artificial entrance to the vagina (AEV): the nephrogonoduct is mobilized to the frontal-urethral ligament, and the posterior and lateral walls of the vagina are mobilized, which is cut off from the nephrogonoduct along the confluence border in two steps, palpatively focusing on the catheter balloon in the vagina, first by an incision along the posterior semicircle of the confluence, and after removing the catheter, by an incision along its anterior semicircle. The defect left after cutting off the vagina is sutured in the transverse direction relative to the nephrogonoduct channel with nodular sutures with absorbable suture material. The narrowing at the entrance to the vaginal canal in the form of a “bottleneck” is dissected in the sagittal direction by a Y-shaped incision for 6 hours of the vaginal canal. The omega-shaped skin flap of the perineum is sewn with the posterior wall of the vagina for 5-7 hours with nodular sutures with the absorbable suture material “polyglactin”, forming an entrance to the vagina with a reference diameter of 10 mm, with a convoluted line of the anastomosis of the posterior wall with this flap. The mobilized part of the nephrogonoduct is longitudinally cut: from the exit to the former confluence point, at 12 and 6 hours of the conventional dial in the section of the nephrogonoduct channel, and a pair of identical mucosal flaps connected to the urethra through a common section, 10 mm long, are obtained, the flaps are deployed with the mucosa outward. The exit of the urethra is formed, then the specified common area of the flaps is laid and sewn, comparing the top of the nephrogonoduct incision for 6 hours with the point for 12 hours of the entrance to the vagina, while continuing the comparison and stitching each of the pair of flaps, respectively, to the left and right with the front and side walls of the entrance to the vagina in the form of the middle part of the letter W, so as to completely cover the front part of the vagina from 12 hours on each side until contact with the sewn skin flap of the perineum for 5 and 7 hours of the back of the vagina. Next, the flaps are laid in the opposite direction to the original, like the sides of the letter W, and sewn with nodal seams with absorbable suture material close to the originally sewn areas of the mucosa: one from 5 to 3 hours, and the other from 7 to 9 hours, the remaining ends of the flaps continue to be laid also towards the urethra and sewn with nodal seams with absorbable the suture material “polyglactin”, size 5/0 on a round needle, forming the AEV. Plastic surgery of the hypertrophied clitoris, form the labia minora is performed. The edges of the wound are sutured.  
     EFFECT: method makes it possible to reduce scarring in the operating area, to achieve vaginal hydration during sexual intercourse, to prevent dryness, irritation and, as a result, inflammation in the AEV area, to prevent hair growth in the vaginal lumen, to reduce the traumatic nature of the operation, as well as to improve the cosmetic and functional results of the operation.  
     4 cl, 22 dwg, 1 tbl, 1 ex