Male Genitoplasty for Intersex Disorders

Abstract

Aim. To evaluate surgical procedures adopted for male genitoplasty in intersex disorders. Patients and Methods. Case records of intersex patients undergoing male genitoplasty from Pediatric Intersex clinic were studied. Results. Of 356 intersex cases undergoing urethroplasty from 1989–2007, the hypospadias was penoscrotal (68%), scrotal (17%) and perineal (15%). 351 patients underwent chordee correction for mild: moderate: severe chordee in 24 : 136 : 191 cases. Byars flaps were fixed upto the corona in 267 cases. Urethroplasty performed was Theirsch duplay in 335 cases, Snodgrass in 16 cases and Ducketts onlay graft in 5 cases that did not require chordee correction. Age at urethroplasty was 2.5 years—22 years (mean 11.5 years, median—5.6 years). Penoscrotal transposition correction and testicular prosthesis insertion were performed independently. Complications included fistula (45), recurrent fistula (11), stricture (12), baggy urethra (8) and recurrent infection due to persistent vaginal pouch (5). Additional distal urethroplasty was required in 15 patients for previous urethroplasty done upto the corona 5–15 years earlier. Conclusion. Hypospadias in intersex disorders is associated with severe chordee in most cases and requires an early chordee correction to allow phallic growth, staged urethroplasty and multiple surgeries to achieve good cosmetic and functional results.

Using of an Alternative Testicular Prosthesis (handmade) at the Department of Urology, Hospital de Clínicas, Asunción – Paraguay School of Medical Sciences – National University of Asunción

“…En la década del 50, diversos materiales fueron utilizados sin mucho éxito: Lucite, vidrio Plexiglass, Dacron, polietileno (7) con diferente morbilidad (7-10). En los años 60 se empleó la primera prótesis testicular de silicona que, al no fijarse, permitía su desplazamiento y rotación que provocaban dolor (12)(13)(14)(15). Alrededor de los '70 se implantaron prótesis testiculares de silicona grado médico con cresta en el polo inferior para permitir su fijación mediante un punto.…”

“…En aquellos pacientes en los que se restaura en otro acto quirúrgico existe una mayor tasa de complicaciones, siendo la más común de ellas la extrusión de la prótesis testicular. Hasta el momento no se ha encontrado asociación entre la aplicación de prótesis de silicona y efectos carcinogénicos o inmunogénicos (13)(14)(15). Es fundamental una cuidadosa técnica quirúrgica para minimizar el riesgo de extrusión.…”

Male genitoplasty for 46 XX congenital adrenal hyperplasia patients presenting late and reared as males

“…[7] This was possibly due to the prenatal exposure of the brain to the androgens and also the social and cultural support provided by the parents. [8] The phallic growth in the absence of steroid therapy for the CAH was satisfactory in six patients and moderate in one patient. One case in this series had formation of the urethra till the tip of the glans penis making the diagnosis difficult.…”

A clinical approach to diagnosis of ambiguous genitalia

“…Feminizing genitoplasty and medical therapy (glucocorticoid/mineralocorticoids supplementation) are the basic management tools. [1213] Occasionally, in late presenters, male genitoplasty has also been performed. [1314]…”