Autologous buccal mucosa vulvovaginoplasty for high urogenital sinus

Feminizing genitoplasty for mid to high urogenital sinus confluence is challenging surgery, especially in the postpubertal patient. We report a surgical alternative for a complex postpubertal case with scarce perineal tissue. An autologous buccal mucosa vulvovaginoplasty was performed in a postpubertal patient with adrenogenital syndrome, permitting vaginal lengthening, creation of labia minora and minimal urethral dissection. This surgical approach avoided female hypospadias, as seen with the total urogenital sinus mobilization repair, and the risks of extensive urethral dissection, seen with the vaginal pull-through procedure, but yet solved the dilemma of mucosal coverage for the vulva and anterior vaginal wall. Buccal mucosa is a natural replacement for the female vulvar and vaginal glabrous skin, and is an excellent adjunct or alternative in challenging reconstructions.