-Case Reports-

Microscope-assisted Reduction Clitoroplasty Used to Treat Two Patients with Clitoromegaly

Masahiro Murakami^1,2, Shigeo Akira³, Narumi Tsuboi^4,5, Ichiro Matsuzawa⁴, Yukashi Ohki⁶, Sachiko Koike¹, Toshiyuki Takeshita³ and Hiko Hyakusoku¹

¹Department of Plastic, Reconstructive and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School
²Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital
³Division of Reproductive Medicine, Perinatology and Gynecologic Oncology, Graduate School of Medicine, Nippon Medical School
⁴Department of Urologic Surgery, Graduate School of Medicine, Nippon Medical School
⁵Department of Urology, Nippon Medical School Chiba Hokusoh Hospital
⁶Department of Pediatrics, Graduate School of Medicine, Nippon Medical School

We report 2 cases of clitoromegaly, 1 in a patient with true hermaphroditism, and the other in a patient with adrenogenital syndrome. Both were treated surgically with reduction clitoroplasty. There are 3 different clitoroplasty procedures: clitorectomy, clitoral recession, and reduction clitoroplasty. Reduction clitoroplasty with preservation of the neurovascular bundle is considered superior in terms of formation of the external genitals and sensation. However, the disadvantages are that detachment of the neurovascular bundle from the clitoral shaft is difficult and that there is a high possibility of sensory and blood flow disorders in the clitoris. In an attempt to achieve safe and reliable surgical manipulation, we used a surgical microscope (OPMI 6-SDFC, Carl Zeiss Surgical GmbH, magnification ×8) to detach the neurovascular bundle from the clitoral shaft in our 2 patients. Our impression is that our efforts were extremely effective. Furthermore, our experience leads us to believe that the procedure for neurovascular bundle detachment required in reduction clitoroplasty is not particularly difficult if performed with a surgical microscope by a plastic surgeon who regularly performs microsurgery. Because the procedure can be performed simply and safely, we believe that reduction clitoroplasty with preservation of the neurovascular bundle is the best overall of the 3 clitoroplasty procedures.

J Nippon Med Sch 2010; 77: 35-39

Keywords
clitoromegaly, reduction clitoroplasty, microscope, true hermaphroditism, adrenogenital syndrome

Correspondence to
Masahiro Murakami, MD, Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
masa2@nms.ac.jp

Received, August 7, 2009
Accepted, October 6, 2009