Chronic inflammation of the bladder as a result of persistent urogenital sinus in girls with a classical form of 21-hydroxylase deficiency

Introduction. The choice of tactics for surgical correction of virilized genitalia in girls with the classic form of congenital adrenal hyperplasia (CAH) remains a topical issue in pediatric surgery. The early one-stage feminization in severe forms of genital virilization, in case of urogenital sinus, is recommended by the international guidelines on CAH clinical practice (2018). One of the arguments for the early one-stage feminizing plasty is to prevent urinary tract infection. However, in experts’ opinion, it has a low level of evidence.

Purpose. To find out a statistically significance risk of developing chronic inflammation in the bladder (CIB) in patients with persistent urogenital sinus due to CAH.

Material and methods. The lower urinary tract was examined in two groups of girls with CAH having non-persistent urogenital sinus (UGS) (n=15) and persistent UGS (n=32). In both groups, cystoscopy was made which is highly specific and sensitive to diagnosing chronic inflammation in the bladder (CIB) which develops as a consequence of long-term disorders in urodynamics and long-term urinary tract infection. Statistical analysis was carried out by comparing 95% confidence interval (95% CI) for the relative frequency of CIB in groups with a population value and for testing the hypotheses on the coincidence of observed and population frequencies of binary trait values using the Chi square criterion (χ²).

Results. The relative CIB frequency in the group with persistent UGS was 75%. As far as the point estimate of population value of the relative CIB frequency (0.1) was located outside the calculated 95% CI (0.581; 0.918) and the value of calculated χ² criterion (148.7813) corresponded to r<0.05 (0.000000), the difference between the obtained data and population values can be considered statistically significant.

Conclusion. The conducted study confirms a high risk of developing CIB in patients with persistent UGS compared to population values what is backgrounded by the obtained statistical significance.