Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study
Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early su...
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| Veröffentlicht in: | Journal of pediatric urology 2021-06, Vol.17 (3), p.379-386 |
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| creator | Long, Christopher J. Van Batavia, Jason Wisniewski, Amy B. Aston, Christopher E. Baskin, Laurence Cheng, Earl Y. Lakshmanan, Yegappan Meyer, Theresa Kropp, Bradley Palmer, Blake Nokoff, Natalie J. Paradis, Alethea VanderBrink, Brian Scott Reyes, Kristy J. Yerkes, Elizabeth Poppas, Dix P. Mullins, Larry L. Kolon, Thomas F. |
| description | Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases includes, but is not limited to, degree of atypia, location of testes, and presence of Mϋllerian remnants. In this study we describe surgical approaches and short-term outcomes for masculinizing genitoplasty in moderate to severe genital atypia in young patients raised male, for whom parents opted for early surgery.
This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3–6 in those with a 46, XY or 45,X/46, XY chromosome complement, age |
| doi_str_mv | 10.1016/j.jpurol.2021.02.006 |
| format | Article |
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This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3–6 in those with a 46, XY or 45,X/46, XY chromosome complement, age <3 years with no previous genitoplasty; patients were included independent of whether genitoplasty was performed. Cosmesis was graded according to a 4-point Likert scale and complications per the Clavian-Dindo classification.
Of the 31 participants, 30 underwent hypospadias repair and 1 patient did not undergo a genitoplasty procedure. The majority of participants (22) received a staged hypospadias repair. Seventeen complications were identified in 12 of the 31 children (41%) at 12 months of follow up. Glans dehiscence and urethrocutaneous fistula were the most common complications. Orchiopexy was performed in 14 (44%) and streak gonads were removed in 4 (13%) participants. Both parents and surgeons reported improved cosmesis after surgery when compared to baseline.
Genitoplasty was chosen by parents for the majority of children eligible for study. No single surgical approach for masculinizing moderate to severe genital ambiguity in young patients with 46, XY or 45,X/46, XY DSD was adopted by all surgeons. Complications occurred in 41% of those who underwent genitoplasty for severe hypospadias. Overall, appearance of the genitals, as determined by parents and surgeons, improved following genitoplasty. Outcomes of early genitoplasty are needed to guide families when making decisions about such procedures for their young children. [Display omitted]</description><identifier>ISSN: 1477-5131</identifier><identifier>ISSN: 1873-4898</identifier><identifier>EISSN: 1873-4898</identifier><identifier>DOI: 10.1016/j.jpurol.2021.02.006</identifier><identifier>PMID: 33726972</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Child ; Child, Preschool ; complications ; Differences of sexual development ; Disorders of Sex Development - surgery ; Disorders of sexual development ; Female ; Genitalia - surgery ; Humans ; Hypospadias ; Male ; Male genitoplasty ; Plastic Surgery Procedures ; Prospective Studies ; Sexual Development</subject><ispartof>Journal of pediatric urology, 2021-06, Vol.17 (3), p.379-386</ispartof><rights>2021 Journal of Pediatric Urology Company</rights><rights>Copyright © 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-e4f07adfcc4a5ffa685037550af41218a1abc8009af658587c9ff8a892bb24633</citedby><cites>FETCH-LOGICAL-c463t-e4f07adfcc4a5ffa685037550af41218a1abc8009af658587c9ff8a892bb24633</cites><orcidid>0000-0002-0799-1738 ; 0000-0001-7286-1895</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1477513121000851$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33726972$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Long, Christopher J.</creatorcontrib><creatorcontrib>Van Batavia, Jason</creatorcontrib><creatorcontrib>Wisniewski, Amy B.</creatorcontrib><creatorcontrib>Aston, Christopher E.</creatorcontrib><creatorcontrib>Baskin, Laurence</creatorcontrib><creatorcontrib>Cheng, Earl Y.</creatorcontrib><creatorcontrib>Lakshmanan, Yegappan</creatorcontrib><creatorcontrib>Meyer, Theresa</creatorcontrib><creatorcontrib>Kropp, Bradley</creatorcontrib><creatorcontrib>Palmer, Blake</creatorcontrib><creatorcontrib>Nokoff, Natalie J.</creatorcontrib><creatorcontrib>Paradis, Alethea</creatorcontrib><creatorcontrib>VanderBrink, Brian</creatorcontrib><creatorcontrib>Scott Reyes, Kristy J.</creatorcontrib><creatorcontrib>Yerkes, Elizabeth</creatorcontrib><creatorcontrib>Poppas, Dix P.</creatorcontrib><creatorcontrib>Mullins, Larry L.</creatorcontrib><creatorcontrib>Kolon, Thomas F.</creatorcontrib><title>Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study</title><title>Journal of pediatric urology</title><addtitle>J Pediatr Urol</addtitle><description>Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases includes, but is not limited to, degree of atypia, location of testes, and presence of Mϋllerian remnants. In this study we describe surgical approaches and short-term outcomes for masculinizing genitoplasty in moderate to severe genital atypia in young patients raised male, for whom parents opted for early surgery.
This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3–6 in those with a 46, XY or 45,X/46, XY chromosome complement, age <3 years with no previous genitoplasty; patients were included independent of whether genitoplasty was performed. Cosmesis was graded according to a 4-point Likert scale and complications per the Clavian-Dindo classification.
Of the 31 participants, 30 underwent hypospadias repair and 1 patient did not undergo a genitoplasty procedure. The majority of participants (22) received a staged hypospadias repair. Seventeen complications were identified in 12 of the 31 children (41%) at 12 months of follow up. Glans dehiscence and urethrocutaneous fistula were the most common complications. Orchiopexy was performed in 14 (44%) and streak gonads were removed in 4 (13%) participants. Both parents and surgeons reported improved cosmesis after surgery when compared to baseline.
Genitoplasty was chosen by parents for the majority of children eligible for study. No single surgical approach for masculinizing moderate to severe genital ambiguity in young patients with 46, XY or 45,X/46, XY DSD was adopted by all surgeons. Complications occurred in 41% of those who underwent genitoplasty for severe hypospadias. Overall, appearance of the genitals, as determined by parents and surgeons, improved following genitoplasty. Outcomes of early genitoplasty are needed to guide families when making decisions about such procedures for their young children. [Display omitted]</description><subject>Child</subject><subject>Child, Preschool</subject><subject>complications</subject><subject>Differences of sexual development</subject><subject>Disorders of Sex Development - surgery</subject><subject>Disorders of sexual development</subject><subject>Female</subject><subject>Genitalia - surgery</subject><subject>Humans</subject><subject>Hypospadias</subject><subject>Male</subject><subject>Male genitoplasty</subject><subject>Plastic Surgery Procedures</subject><subject>Prospective Studies</subject><subject>Sexual Development</subject><issn>1477-5131</issn><issn>1873-4898</issn><issn>1873-4898</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uc1u1DAQjhCIlsIbIOQjBxJs58_hgFRVFJAqwQHO1sQZb71y4mA7Qcsj8ZR12KXAhZM9mu9nZr4se85owShrXu-L_bx4ZwtOOSsoLyhtHmTnTLRlXolOPEz_qm3zmpXsLHsSwp7SsqW8e5ydlWXLm67l59nPzy7E3M3oIZoViXLjbI1KhZsC0c5a991MOzJCUIs1k_mxVTucTHSzhRAPxExkdMMmgCQ6EnBFj0cIWALxMBt4QzyGxcYk6d1IgIypMAqniP4VcX1Av_7yTIzZuzCjOo1z63wkIS7D4Wn2SIMN-Oz0XmRfr999ufqQ33x6__Hq8iZXVVPGHCtNWxi0UhXUWkMj6rR3XVPQFeNMAINeCUo70E0tatGqTmsBouN9z5NCeZG9PerOSz_isA3pwcrZmxH8QTow8t_OZG7lzq1StKwsa54EXp4EvPu2YIhyNEGhtTChW4LkNeWcsa7aoNURqtLSwaO-t2FUbjHLvTzGLLeYJeUyxZxoL_4e8Z70O9c_O2A61GrQy6AMTgoH49Np5eDM_x3uAD4ww10</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Long, Christopher J.</creator><creator>Van Batavia, Jason</creator><creator>Wisniewski, Amy B.</creator><creator>Aston, Christopher E.</creator><creator>Baskin, Laurence</creator><creator>Cheng, Earl Y.</creator><creator>Lakshmanan, Yegappan</creator><creator>Meyer, Theresa</creator><creator>Kropp, Bradley</creator><creator>Palmer, Blake</creator><creator>Nokoff, Natalie J.</creator><creator>Paradis, Alethea</creator><creator>VanderBrink, Brian</creator><creator>Scott Reyes, Kristy J.</creator><creator>Yerkes, Elizabeth</creator><creator>Poppas, Dix P.</creator><creator>Mullins, Larry L.</creator><creator>Kolon, Thomas F.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0799-1738</orcidid><orcidid>https://orcid.org/0000-0001-7286-1895</orcidid></search><sort><creationdate>20210601</creationdate><title>Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study</title><author>Long, Christopher J. ; Van Batavia, Jason ; Wisniewski, Amy B. ; Aston, Christopher E. ; Baskin, Laurence ; Cheng, Earl Y. ; Lakshmanan, Yegappan ; Meyer, Theresa ; Kropp, Bradley ; Palmer, Blake ; Nokoff, Natalie J. ; Paradis, Alethea ; VanderBrink, Brian ; Scott Reyes, Kristy J. ; Yerkes, Elizabeth ; Poppas, Dix P. ; Mullins, Larry L. ; Kolon, Thomas F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-e4f07adfcc4a5ffa685037550af41218a1abc8009af658587c9ff8a892bb24633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Child</topic><topic>Child, Preschool</topic><topic>complications</topic><topic>Differences of sexual development</topic><topic>Disorders of Sex Development - surgery</topic><topic>Disorders of sexual development</topic><topic>Female</topic><topic>Genitalia - surgery</topic><topic>Humans</topic><topic>Hypospadias</topic><topic>Male</topic><topic>Male genitoplasty</topic><topic>Plastic Surgery Procedures</topic><topic>Prospective Studies</topic><topic>Sexual Development</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Long, Christopher J.</creatorcontrib><creatorcontrib>Van Batavia, Jason</creatorcontrib><creatorcontrib>Wisniewski, Amy B.</creatorcontrib><creatorcontrib>Aston, Christopher E.</creatorcontrib><creatorcontrib>Baskin, Laurence</creatorcontrib><creatorcontrib>Cheng, Earl Y.</creatorcontrib><creatorcontrib>Lakshmanan, Yegappan</creatorcontrib><creatorcontrib>Meyer, Theresa</creatorcontrib><creatorcontrib>Kropp, Bradley</creatorcontrib><creatorcontrib>Palmer, Blake</creatorcontrib><creatorcontrib>Nokoff, Natalie J.</creatorcontrib><creatorcontrib>Paradis, Alethea</creatorcontrib><creatorcontrib>VanderBrink, Brian</creatorcontrib><creatorcontrib>Scott Reyes, Kristy J.</creatorcontrib><creatorcontrib>Yerkes, Elizabeth</creatorcontrib><creatorcontrib>Poppas, Dix P.</creatorcontrib><creatorcontrib>Mullins, Larry L.</creatorcontrib><creatorcontrib>Kolon, Thomas F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of pediatric urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Long, Christopher J.</au><au>Van Batavia, Jason</au><au>Wisniewski, Amy B.</au><au>Aston, Christopher E.</au><au>Baskin, Laurence</au><au>Cheng, Earl Y.</au><au>Lakshmanan, Yegappan</au><au>Meyer, Theresa</au><au>Kropp, Bradley</au><au>Palmer, Blake</au><au>Nokoff, Natalie J.</au><au>Paradis, Alethea</au><au>VanderBrink, Brian</au><au>Scott Reyes, Kristy J.</au><au>Yerkes, Elizabeth</au><au>Poppas, Dix P.</au><au>Mullins, Larry L.</au><au>Kolon, Thomas F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study</atitle><jtitle>Journal of pediatric urology</jtitle><addtitle>J Pediatr Urol</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>17</volume><issue>3</issue><spage>379</spage><epage>386</epage><pages>379-386</pages><issn>1477-5131</issn><issn>1873-4898</issn><eissn>1873-4898</eissn><abstract>Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases includes, but is not limited to, degree of atypia, location of testes, and presence of Mϋllerian remnants. In this study we describe surgical approaches and short-term outcomes for masculinizing genitoplasty in moderate to severe genital atypia in young patients raised male, for whom parents opted for early surgery.
This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3–6 in those with a 46, XY or 45,X/46, XY chromosome complement, age <3 years with no previous genitoplasty; patients were included independent of whether genitoplasty was performed. Cosmesis was graded according to a 4-point Likert scale and complications per the Clavian-Dindo classification.
Of the 31 participants, 30 underwent hypospadias repair and 1 patient did not undergo a genitoplasty procedure. The majority of participants (22) received a staged hypospadias repair. Seventeen complications were identified in 12 of the 31 children (41%) at 12 months of follow up. Glans dehiscence and urethrocutaneous fistula were the most common complications. Orchiopexy was performed in 14 (44%) and streak gonads were removed in 4 (13%) participants. Both parents and surgeons reported improved cosmesis after surgery when compared to baseline.
Genitoplasty was chosen by parents for the majority of children eligible for study. No single surgical approach for masculinizing moderate to severe genital ambiguity in young patients with 46, XY or 45,X/46, XY DSD was adopted by all surgeons. Complications occurred in 41% of those who underwent genitoplasty for severe hypospadias. Overall, appearance of the genitals, as determined by parents and surgeons, improved following genitoplasty. Outcomes of early genitoplasty are needed to guide families when making decisions about such procedures for their young children. [Display omitted]</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>33726972</pmid><doi>10.1016/j.jpurol.2021.02.006</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-0799-1738</orcidid><orcidid>https://orcid.org/0000-0001-7286-1895</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of pediatric urology, 2021-06, Vol.17 (3), p.379-386 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Child Child, Preschool complications Differences of sexual development Disorders of Sex Development - surgery Disorders of sexual development Female Genitalia - surgery Humans Hypospadias Male Male genitoplasty Plastic Surgery Procedures Prospective Studies Sexual Development |
| title | Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study |
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