Masculinizing Genitoplasty in Intersex Patients (Severe Hypospadias)
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Date
2008-11-16
Authors
Dr. Jehad M. Abu Daia
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Abstract
<p>Purpose: Perineal & scrotal forms are the most severe, uncommon and challenging variants in the spectrum of hypospadias These forms are often associated with extreme chordee, penoscrotaltransposition and bifid or absent scrotum We reviewed cosmetic and functional outcome of masculinizing genitoplasty (MGP) in intersex patients assigned as a male performed in our service in the last 6 years.</p>
<p>Materials and Methods: A total of55 patients underwent MPG by one surgeon during 6 year period. Patient age ranged from 6 months to 16 years .The presenting disease was severe hypospadias or intersex, scrotal hypospadias in 30 cases , and perineal hypospadias in 25 .Some patients were evaluated for gender, chromosomal and biochemical data by pediatric endocrinologists. Most of our patients had idiopathic male pseudohermaphroditism.. MGP was performed using Augmented Koyanagi Nonomura one-stage surgical techniques in the first 2 years,then we used extended unilateral parameatal flape with minimal mobilization technique in the next 4 years, dorsal plication needed in7 patients.Scrotoplasty and orchiopexy was performed in the same operation. 21 First International Faculty of Medicine Conference 2008</p>
<p>Results: Followup was 1 to 6 years. Satisfactory cosmetic and functional results in terms of good urinary stream and straight phallus in ( 72%) of cases . Complications requiring reoperation occurred in (28%). complications presented are various degrees of failure of the urethroplasty or cosmetic appearance.95% of patients have satisfactory result after the second operation.</p>
<p>Conclusions: Male pseudohermaphroditism better to be managed by single stage male genitoplasty, a second operation may be needed only in about 25% of cases ( patients with complications from the first operation) . In order to achieve a longer new urethra we recommend our modified technique – the extended parameatal-based flap with minimal moblization urethroplasty.</p>
<p>Purpose: Perineal & scrotal forms are the most severe, uncommon and challenging variants in the spectrum of hypospadias These forms are often associated with extreme chordee, penoscrotaltransposition and bifid or absent scrotum We reviewed cosmetic and functional outcome of masculinizing genitoplasty (MGP) in intersex patients assigned as a male performed in our service in the last 6 years.</p> <p>Materials and Methods: A total of55 patients underwent MPG by one surgeon during 6 year period. Patient age ranged from 6 months to 16 years .The presenting disease was severe hypospadias or intersex, scrotal hypospadias in 30 cases , and perineal hypospadias in 25 .Some patients were evaluated for gender, chromosomal and biochemical data by pediatric endocrinologists. Most of our patients had idiopathic male pseudohermaphroditism.. MGP was performed using Augmented Koyanagi Nonomura one-stage surgical techniques in the first 2 years,then we used extended unilateral parameatal flape with minimal mobilization technique in the next 4 years, dorsal plication needed in7 patients.Scrotoplasty and orchiopexy was performed in the same operation. 21 First International Faculty of Medicine Conference 2008</p> <p>Results: Followup was 1 to 6 years. Satisfactory cosmetic and functional results in terms of good urinary stream and straight phallus in ( 72%) of cases . Complications requiring reoperation occurred in (28%). complications presented are various degrees of failure of the urethroplasty or cosmetic appearance.95% of patients have satisfactory result after the second operation.</p> <p>Conclusions: Male pseudohermaphroditism better to be managed by single stage male genitoplasty, a second operation may be needed only in about 25% of cases ( patients with complications from the first operation) . In order to achieve a longer new urethra we recommend our modified technique – the extended parameatal-based flap with minimal moblization urethroplasty.</p>
<p>Purpose: Perineal & scrotal forms are the most severe, uncommon and challenging variants in the spectrum of hypospadias These forms are often associated with extreme chordee, penoscrotaltransposition and bifid or absent scrotum We reviewed cosmetic and functional outcome of masculinizing genitoplasty (MGP) in intersex patients assigned as a male performed in our service in the last 6 years.</p> <p>Materials and Methods: A total of55 patients underwent MPG by one surgeon during 6 year period. Patient age ranged from 6 months to 16 years .The presenting disease was severe hypospadias or intersex, scrotal hypospadias in 30 cases , and perineal hypospadias in 25 .Some patients were evaluated for gender, chromosomal and biochemical data by pediatric endocrinologists. Most of our patients had idiopathic male pseudohermaphroditism.. MGP was performed using Augmented Koyanagi Nonomura one-stage surgical techniques in the first 2 years,then we used extended unilateral parameatal flape with minimal mobilization technique in the next 4 years, dorsal plication needed in7 patients.Scrotoplasty and orchiopexy was performed in the same operation. 21 First International Faculty of Medicine Conference 2008</p> <p>Results: Followup was 1 to 6 years. Satisfactory cosmetic and functional results in terms of good urinary stream and straight phallus in ( 72%) of cases . Complications requiring reoperation occurred in (28%). complications presented are various degrees of failure of the urethroplasty or cosmetic appearance.95% of patients have satisfactory result after the second operation.</p> <p>Conclusions: Male pseudohermaphroditism better to be managed by single stage male genitoplasty, a second operation may be needed only in about 25% of cases ( patients with complications from the first operation) . In order to achieve a longer new urethra we recommend our modified technique – the extended parameatal-based flap with minimal moblization urethroplasty.</p>