Multidisciplinary Management of Disorders of Sex Development in Indonesia, A Prototype in Developing Country

Abstract

Background : Disorder of sex development (DSD) patients require comprehensive management to improve quality of life. A standardized management protocol for patients in Indonesia is not yet available resulting in patients infrequently received a proper diagnosis and appropriate gender assignment. Objectives : The purpose of the study was to report the management of DSD patients in Indonesia with regards to minimal diagnostic facilities and expertise in developing country. Methodology : We analyzed DSD patients managed by Sexual Adjustment Multidisciplinary Team (SAT) through the record at Center for Biomedical Research Faculty of Medicine Diponegoro University, from May 2004 -December 2015 and bimonthly multidisciplinary SAT meeting. The team was consist of endocrinologist, andrologist, urologist, plastic surgeon, gynaecologist, anesthesiologist, medical geneticist, psychiatrist, psychologist, pathology, legal medicine, religion and social-medical staffs. Data were grouped by diagnosis that based on physical examination, family pedigree, karyotyping, hormonal assays and other examination such as ultrasonography, X-ray, and cytoscopy for selected cases. Results : From the total of 617 cases we found 426 cases with 46,XY DSD (69.04 %), 117 cases with 46,XX DSD (18.96%), and 74 cases with sex chromosome DSD (12%). Most of the patients in the group of 46,XY DSD were Unknown Male Undervirilization (60.09%) followed by Congenital Adrenal Hyperplasia (69.23%) in 46, XX DSD group. Conclusion : Comprehensive management for DSD Patients help patient in diagnosis, gender assignment and support patient to improve quality of life. This multidisciplinary of DSD team is the only team in Indonesia that can be used as a model for other center in Indonesia as well as other developing countries with minimal diagnostic facilities.

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