Ambiguous genitalia: an overview of 17 years' experience.
OBJECTIVE
The newborn with abnormal genital development presents a difficult diagnostic and treatment challenge for the pediatric surgeon providing care. The purpose of this study was to evaluate the results of surgical treatment for children with ambiguous genitalia.


METHODS
The records of 85 children managed surgically for ambiguous genitalia in our unit from 1988 to 2005 were reviewed retrospectively. Age at surgery, operative procedures, sex of rearing, and outcome were recorded.


RESULTS
The intersex committee's decision concerning sex assignment was female for 62 children (75%) and male for 23 children (25%). The etiologies of children reared as female were congenital adrenal hyperplasia (n = 37), male pseudohermaphroditism (n = 12), mixed gonadal dysgenesis (n = 6), true hermaphroditism (n = 4), and Mayer-Rokitansky syndrome (n = 3). Fifteen children with male pseudohermaphroditism, 5 children with congenital adrenal hyperplasia, and 3 children with true hermaphroditism were reared as male. The mean age at surgery was 4.4 years and follow-up period averaged 7 years. Eighteen (29%) patients with feminization procedures and 8 (34%) of 23 patients with masculinization procedures experienced complications and required redo operations. Vaginal stenosis was the most common complication.


CONCLUSIONS
The surgical management of ambiguous genitalia has always been difficult, and it must be performed by skilled pediatric surgeon. Genital surgery in infancy needs to be reassessed in the light of literature findings revealing poor outcome. In patients who underwent feminizing genitoplasty, vaginal reconstruction should be delayed until adolescence to achieve better cosmetic and functional results.
Göllü
Gülnur
G
Department of Pediatric Surgery, Ankara University School of Medicine, 06100 Ankara, Turkey.
Yildiz
Rahsan Vargün
RV
Bingol-Kologlu
Meltem
M
Yagmurlu
Aydin
A
Senyücel
Mine Fedakar
MF
Aktug
Tanju
T
Gökcora
I Haluk
IH
Dindar
Hüseyin
H
D002648:Child; D002675:Child, Preschool; D012734:Disorders of Sex Development / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome