[Surgery of sexual ambiguity: experience of 298 cases]

From 1955 to 1988, 298 children suffering of ambiguous genitalia were operated upon in the Department of Pediatric Surgery, Hospital Necker-Enfants Malades, Paris. 187 were female pseudo-hermaphroditism (of which 85% congenital adrenal hyperplasia). 53 gonadal dysgenesis and 58 male pseudohermaphroditism--Feminizing genitoplasty, including relocation of the clitoris, published by us, in 1961, was made in 238 cases. It was for a long time the best procedure used, whatever be the etiology of intersex, because the results of masculinizing procedures to be used were poor. Using free bladder mucosa graft is a progress which allows an efficient one stage masculinizing genitoplasty, we have made 31 cases of it. Early and precise diagnosis, early medical treatment and psychological approach of intersex by a multidisciplinary team and adequate precocious one stage surgical repair of ambiguous genitalia, have dramatically improved this condition. Prenatal diagnosis of C21 hydroxylase deficiency and preventive control of adrenal hyperplasia of the foetus, by the supply of gluco-corticoïds to the mother in "a risk situation", will in the future allow to prevent virilisation of female foetuses--Surgery will become useless.