V7-04: Mons Plasty: A Technique for Optimal Aesthetic Outcome
It has been suggested that women who have undergone repair for exstrophy-epispadias complex (EEC) have unsatisfactory cosmetic results possibly leading to decreased self-esteem. Here we aim to show a mons plasty technique to be incorporated at the initial EEC closure that creates anatomically correct external female genitalia as well as improves the aesthetic outcome.
Briefly, the surgical technique incorporates approximation of the bifid clitoris in the midline, aligning the labia minora along the lateral aspect of the introitus, creation of a clitoral hood, superomedial rotation of the labia majora, and finally mobilization of peripubic adipose to create a mons.
In our experience the surgical technique was successful in creating anatomically normal appearing external genitalia with subjective parental satisfaction. The patient has not had any complications. A post-operative VCUG showed grade 3 left vesicoureteral reflux. She is not yet potty trained but does have apparent normal voiding with dry periods throughout the day.
The technique described restores normal anatomic appearance as well as improves the cosmetic outcome. This technique should be considered in one-stage female EEC closure.