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Practice changes in childhood surgery for ambiguous genitalia?
Lina Michala1, Lih-Mei Liao1, Dan Wood1
1University College London Hospitals, London, UK.
Journal of Pediatric Urology
|March 25, 2014
Summary
Surgical outcomes for adolescent girls with ambiguous genitalia show slight improvement, with fewer vaginoplasties but persistent high rates of clitoral surgery. Further changes in pediatric surgical practice are needed for better long-term results.
Area of Science:
- Pediatric Surgery
- Endocrinology
- Genetics
Background:
- Childhood feminizing genital surgery for ambiguous genitalia has faced scrutiny due to poor outcomes.
- The Chicago Consensus Document (2006) called for changes in surgical practices.
- Previous studies highlighted challenges in adolescent outcomes following early surgical interventions.
Purpose of the Study:
- To evaluate clinical outcomes in a recent cohort of adolescent girls with ambiguous genitalia.
- To compare current outcomes with a historical cohort to assess changes in pediatric surgical practice.
- To identify trends in surgical management and outcomes for disorders of sex development (DSD).
Main Methods:
- Observational study comparing two cohorts of adolescent girls treated for ambiguous genitalia.
- Data collected on surgical history, genital examination, and treatment recommendations.
- Comparison of outcomes between a current cohort (30 adolescents over 5 years) and a historical cohort.
Main Results:
- Clitoral surgery remains highly prevalent (93% in the current cohort).
- Vaginoplasty rates decreased, with fewer required revisions, though 24% still needed major revision.
- Cosmetic outcomes showed some improvement, as assessed by the surgical team.
Conclusions:
- Recent pediatric surgical practice shows minor changes, with reduced vaginoplasties and improved outcomes.
- Management of clitoromegaly has not changed, with high rates of clitoral reduction surgery persisting.
- Further shifts in surgical approaches are warranted, considering the impact on clitoral sensation and sexual function.
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