Elsevier

Journal of Pediatric Surgery

Volume 40, Issue 12, December 2005, Pages 1856-1860
Journal of Pediatric Surgery

Cosmetic and anatomic outcomes after feminizing surgery for ambiguous genitalia

https://doi.org/10.1016/j.jpedsurg.2005.08.045Get rights and content

Abstract

Background

Reports on anatomic and cosmetic outcomes after genital surgery for children with ambiguous genitalia are mixed, with recent reports using standardized assessments suggesting poor outcomes and that multiple operations may be required.

Methods

All children with ambiguous genitalia and who had feminizing surgery at the Royal Children's Hospital in Melbourne, Australia, were identified. Standardized genital assessment was undertaken at their clinical review after informed consent. Underlying diagnosis, number and type of procedures performed, and the expertise of the surgeon were recorded from their medical notes.

Results

Of 32 patients examined aged 13 to 33 years, 47% had congenital adrenal hyperplasia. Ten patients had initial surgery performed elsewhere. Overall, there were good anatomic and cosmetic outcomes for those initially treated at our institute by a specialized surgeon, although some required additional intervention in adolescence or adulthood. Initial surgery before or after 2 years of age did not significantly affect outcomes. Those patients who had only 1 operation (by a surgeon with special interest in intersex) had better cosmetic and anatomic outcomes than those patients who had multiple operations.

Conclusions

Cosmetic and anatomic outcomes of surgery for ambiguous genitalia were generally good when undertaken by pediatric surgeons with specific expertise in intersex surgery.

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

Cited by (43)

  • Congenital adrenal hyperplasia: Does repair after two years of age have a worse outcome?

    2020, Journal of Pediatric Urology
    Citation 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.

  • Management of disorders of sex development – With a focus on development of the child and adolescent through the pubertal years

    2019, Best Practice and Research: Clinical Endocrinology and Metabolism
    Citation 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 Edition
View all citing articles on Scopus

Presented at the 38th Annual Meeting of the Pacific Association of Pediatric Surgeons, May 22-26, 2005, Vancouver, Canada.

View full text