{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:18:28Z","timestamp":1787739508826,"version":"build-2784847793"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002352","name":"Ain Shams University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Congenital adrenal hyperplasia is an endocrine disorder that leads to external virilization in affected females, often accompanied by an abnormal vaginal insertion that joins the urethra, forming a common urogenital sinus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We propose a new anatomical classification for common urogenital sinus anomalies based on the relationship between the distal vagina and the ischial bony landmark on lateral genitography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>The study included girls with virilized external genitalia secondary to congenital adrenal hyperplasia who underwent feminizing genitoplasty between 2016 and 2025. Data maintained by the author were analyzed retrospectively. On lateral genitography, the level of the distal vagina was referenced to the inferior end of the ischium (I-point). A vagina reaching the level of the I-point indicates a low vaginal insertion near the perineum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 21 girls with available preoperative genitograms for comparison with intraoperative findings. Their age at surgery ranged from 9 months to 108\u00a0months (mean 47, median 36). In most cases (19 patients; 90%), the distal vagina was low, extending to a level near the \u201cI-point,\u201d whether slightly below, at, or just above it. In contrast, two cases (10%) demonstrated a high vaginal position, with the vaginal take-off arising from the posterior urethra opposite the mid-ischium. Imaging-based stratification showed well consistence with operative findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most cases of congenital adrenal hyperplasia demonstrate a low vaginal insertion near the perineum. The proposed classification provides a useful tool for identifying the uncommon cases with a high vaginal take-off, which is important for preoperative planning and patient counseling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00247-026-06756-2","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:27:48Z","timestamp":1787736468000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The ischium as a key anatomical landmark in the classification of persistent urogenital sinus anomalies"],"prefix":"10.1007","author":[{"given":"Amr Abdelhamid","family":"AbouZeid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaimaa Abdelsattar","family":"Mohammad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila Rawash","family":"ElDieb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"6756_CR1","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.jsbmb.2016.03.021","volume":"165","author":"LC Wang","year":"2017","unstructured":"Wang LC, Poppas DP (2017) Surgical outcomes and complications of reconstructive surgery in the female congenital adrenal hyperplasia patient: what every endocrinologist should know. J Steroid Biochem Mol Biol 165:137\u2013144","journal-title":"J Steroid Biochem Mol Biol"},{"key":"6756_CR2","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1055\/s-0029-1233490","volume":"19","author":"LH Braga","year":"2009","unstructured":"Braga LH, Pippi Salle JL (2009) Congenital adrenal hyperplasia: a critical appraisal of the evolution of feminizing genitoplasty and the controversies surrounding gender reassignment. Eur J Pediatr Surg 19:203\u2013210","journal-title":"Eur J Pediatr Surg"},{"key":"6756_CR3","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1053\/j.semperi.2017.03.011","volume":"41","author":"LS Baskin","year":"2017","unstructured":"Baskin LS (2017) Restoring normal anatomy in female patients with atypical genitalia. Semin Perinatol 41:227\u2013231","journal-title":"Semin Perinatol"},{"key":"6756_CR4","doi-asserted-by":"publisher","first-page":"282.e1","DOI":"10.1016\/j.jpurol.2016.02.008","volume":"12","author":"MM Marei","year":"2016","unstructured":"Marei MM, Fares AE, Abdelsattar AH et al (2016) Anatomical measurements of the urogenital sinus in virilized female children due to congenital adrenal hyperplasia. J Pediatr Urol 12:282.e1-282.e8","journal-title":"J Pediatr Urol"},{"key":"6756_CR5","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1111\/j.1464-410X.2005.05354.x","volume":"95","author":"RC Rink","year":"2005","unstructured":"Rink RC, Adams MC, Misseri R (2005) A new classification for genital ambiguity and urogenital sinus anomalies. BJU Int 95:638\u2013642","journal-title":"BJU Int"},{"key":"6756_CR6","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1016\/j.juro.2006.07.078","volume":"176","author":"RC Rink","year":"2006","unstructured":"Rink RC, Metcalfe PD, Cain MP et al (2006) Use of the mobilized sinus with total urogenital mobilization. J Urol 176:2205\u20132211","journal-title":"J Urol"},{"key":"6756_CR7","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.jpurol.2006.04.002","volume":"2","author":"RC Rink","year":"2006","unstructured":"Rink RC, Metcalfe PD, Kaefer MA et al (2006) Partial urogenital mobilization: a limited proximal dissection. J Pediatr Urol 2:351\u2013356","journal-title":"J Pediatr Urol"},{"key":"6756_CR8","first-page":"247","volume-title":"Anorectal malformations in children: update 1988","author":"D Smith","year":"1988","unstructured":"Smith D, Cywes S (1988) Diagnosis and investigations. In: Stephens FD, Smith ED, Paul NW (eds) Anorectal malformations in children: update 1988. Alan R., Liss Inc., New York, pp 247\u2013299"},{"key":"6756_CR9","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s43054-025-00434-y","volume":"73","author":"AA AbouZeid","year":"2025","unstructured":"AbouZeid AA, Abdelmoniem AS, Arafa AB et al (2025) Neonatal PSARP: recalling the traditional classifications of anorectal anomalies. Egypt Pediatr Assoc Gaz 73:82","journal-title":"Egypt Pediatr Assoc Gaz"},{"key":"6756_CR10","unstructured":"Pediatric Radiology & Imaging | Radiation Safety \u2013 Image Gently. https:\/\/www.imagegently.org\/. Accessed 1 May 2026"},{"key":"6756_CR11","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s43159-020-00044-w","volume":"16","author":"AA AbouZeid","year":"2020","unstructured":"AbouZeid AA (2020) Feminizing genitoplasty in childhood: aiming for achievable outcomes. Ann Pediatr Surg 16:34","journal-title":"Ann Pediatr Surg"},{"key":"6756_CR12","doi-asserted-by":"publisher","first-page":"1709","DOI":"10.1016\/j.juro.2008.03.089","volume":"180","author":"N Kalfa","year":"2008","unstructured":"Kalfa N, Liu B, Cao M et al (2008) 3-dimensional neuroanatomy of the human fetal pelvis: anatomical support for partial urogenital mobilization in the treatment of urogenital sinus. J Urol 180:1709\u20131715","journal-title":"J Urol"},{"key":"6756_CR13","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/0022-3468(69)90183-3","volume":"4","author":"W Hardy Hendren","year":"1969","unstructured":"Hardy Hendren W, Crawford JD (1969) Adrenogenital syndrome: the anatomy of the anomaly and its repair. Some new concepts. J Pediatr Surg 4:49\u201358","journal-title":"J Pediatr Surg"},{"key":"6756_CR14","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/S0022-5347(05)65448-1","volume":"167","author":"A Ganesan","year":"2002","unstructured":"Ganesan A, Smith GHH, Broome K, Steinberg A (2002) Congenital adrenal hyperplasia: preliminary observations of the urethra in 9 cases. J Urol 167:275\u2013279","journal-title":"J Urol"},{"key":"6756_CR15","doi-asserted-by":"publisher","first-page":"611.e1","DOI":"10.1016\/j.jpurol.2022.07.007","volume":"18","author":"S Hennayake","year":"2022","unstructured":"Hennayake S, Barnes A, Mariotto A et al (2022) 45 years\u2019 experience with early childhood anatomical technique of feminising genitoplasty for 46 XX congenital adrenal hyperplasia \u2013observations of vaginal introital anatomy and its relationship to the perineal body. J Pediatr Urol 18:611.e1-611.e8","journal-title":"J Pediatr Urol"},{"key":"6756_CR16","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1002\/ar.23541","volume":"300","author":"SW Verbruggen","year":"2017","unstructured":"Verbruggen SW, Nowlan NC (2017) Ontogeny of the human pelvis. Anat Rec 300:643\u2013652","journal-title":"Anat Rec"}],"container-title":["Pediatric Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00247-026-06756-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00247-026-06756-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00247-026-06756-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:27:50Z","timestamp":1787736470000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00247-026-06756-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":16,"alternative-id":["6756"],"URL":"https:\/\/doi.org\/10.1007\/s00247-026-06756-2","relation":{},"ISSN":["1432-1998"],"issn-type":[{"value":"1432-1998","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"assertion":[{"value":"1 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 August 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"None","order":1,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}