Cosmetic and anatomic outcomes after feminizing surgery for ambiguous genitalia
Section snippets
Methods
This is a cross-sectional, retrospective study of a cohort of intersex patients aged 13 to 33 years who underwent feminizing genital surgery for ambiguous genitalia at Royal Children's Hospital (RCH). Patients were identified through a medical records search and was limited to patients who were born between 1970 and 1991.Younger patients were excluded because it has been standard practice at our institute during the last 15 years to avoid genital examination in young girls who are not mature
Results
Of the 82 patients identified from the hospital records, 21 had moved interstate or were from overseas and did not have any contact with the hospital after the surgery. A representative sample of 32 patients were examined at the gynecology clinic. Of the patients who were not examined, 23 of 29 had their operation done by surgeons with expertise in reconstructive genital surgery (ie, a similar percentage as in the examined population). A single reconstruction was performed in 18 of 29, and most
Discussion
This audit project suggested that planned 1-stage surgery gave a better outcome than multistage genital surgery, with 88% of patients who underwent 1-stage genital surgery having a good cosmetic outcome. In addition, having a single operation also appeared to produce better overall outcomes because repeated surgery may cause more scarring and fibrosis [3].
Although this study demonstrated no effect of age at surgery on outcome, there was a clear correlation with outcome surgery done by surgeons
References (14)
- et al.
Objective cosmetic and anatomical outcomes at adolescence of feminising surgery for ambiguous genitalia done in childhood
Lancet
(2001) - et al.
Feminizing genitoplasty for CAH: what happens at puberty?
J Urol
(1999) - et al.
The complications of surgery for intersex: changing patterns over two decades
J Pediatr Surg
(1987) - et al.
Long-term assessment of genital reconstruction in female pseudohermaphrodites
J Urol
(1976) - et al.
Single-stage feminization genitoplasty
J Urol
(1990) - et al.
Some surgical aspects of adrenal virilization in the female
J Pediatr Surg
(1967) - et al.
Clitoroplasty for females born with ambiguous genitalia: a long-term study of 37 patients
J Pediatr Surg
(1981)
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Treatment and outcome of congenital adrenal hyperplasia: current reconstructive surgery
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2020, Journal of Pediatric UrologyCitation Excerpt :Good cosmetic results (97.4%) are found more with the one stage operations, while poor cosmetic results (28.6%) are more commonly observed with the two stages operations. This result is in harmony with others who found that out of 32 operated children for feminizing genitoplasty they had single stage repair in 16 children and they had satisfactory outcome in 88% of planned single stage repair which made their conclusion that early planned single stage repair is associated with better outcome and staged repair may result in scarring and fibrosis with paucity of tissues that make future surgery more complicated which is similar to our experience [4]. In a vicinity similar to ours, Eltagy et al. [13] found that early repair is more satisfactory to parents of children with congenital adrenal hyperplasia who think that early repair is in the best interest of their children and levitates their tension regarding rearing and future surgery of their girls, they operated 30 children with a mean age of 22 months and found both satisfactory outcome and parent satisfaction is high in their group of children.
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2019, Best Practice and Research: Clinical Endocrinology and MetabolismCitation Excerpt :The surgery should reduce risk of future cancer and allow development of social identities [18]. The surgical outcomes after feminizing genitoplasty are generally reported good in hands of pediatric surgeons with specific expertise in DSD surgery [25] with a complication rate of 7.6% Post-operative infections and urinary incontinence are rare but can be seen in total urethral mobilization (TUM) [26]). Vaginal stenosis is a possible complication of vaginal reconstruction requiring evaluation as child grows and correction if significant.
Gender Identity in Disorders of Sex Development
2017, Principles of Gender-Specific Medicine: Gender in the Genomic Era: Third EditionSurgical outcomes and complications of reconstructive surgery in the female congenital adrenal hyperplasia patient: What every endocrinologist should know
2017, Journal of Steroid Biochemistry and Molecular Biology
Presented at the 38th Annual Meeting of the Pacific Association of Pediatric Surgeons, May 22-26, 2005, Vancouver, Canada.