有腟半陰陽に対する遠位尿道利用女性外陰部形成術

SIMGLE-STAGE FEMINIZING GENITOPLASTY USING DISTAL URETHRA In MASCULINIZED HERMAPHRODITE

　60歳，半陰陽．性染色体はXO／XY．外陰部は陰嚢部尿道下裂の形態．生活環境が変わるため，女性外陰部形成術を希望して来科．逆行性尿道造影で発達した腟が造影され，内視鏡検査で腟は外尿道括約筋近くに開口していた．尿生殖隔膜を切開して腟開口部を切離した後，平板化した遠位尿道を腟上壁，逆U字型会陰皮弁を下壁，陰嚢皮弁を側壁とする遠位腟を形成した．この手術法は男性化の強い，包皮の短い有腟半陰陽に適応がある．

A 60-year-old hermaphrodite raised as a female came to us to undergo a feminizing genitoplasty. The patient had a male phenotype, a scrotal hypospadias and an XO/XY karyotype. Retrograde sinography and endoscopic examination demonstrated a large vagina opening into the urogenital sinus near the external sphincter. We performed a modified technique for vaginoplasty, which combined the main features of the Passerini-Glazel and the Hendren and Crawford operations. An opened distal "urethra" (urogenital sinus) was used to construct an anterior vaginal wall.