Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

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09:28 - 09:31
S13-6 (PP)
EARLY VS. LATE INTERVENTION IN PATIENTS WITH DISORDERS OF SEXUAL
DEVELOPMENT (DSD)
Maria Helena SIRCILI1, Sorahia Domenice DOMENICE 2, Elaine FRADE COSTA2, Marlene INACIO3, Tania BACHEGA2,
Lorena MARÇALO1, Paulo Afonso CARVALHO1, Berenice Bilharinho MENDONÇA2 and Francisco Tibor DENES1
1) Hospital of Clinics of the University of São Paulo, Urology, São Paulo, BRAZIL - 2) Hospital of Clinics of the University
of São Paulo, Endocrinology, São Paulo, BRAZIL - 3) Hospital of Clinics of the University of São Paulo, Psychology, São
Paulo, BRAZIL
PURPOSE
Ideal age for genital surgery in patients with DSD continues to be intensively debated. Many authors defend surgical
approach in infancy, but later surgical reconstruction has been suggested. Our aim is to present the long-term outcomes
of a cohort of patients who had genital surgery in infancy and adult life treated at the same tertiary centre.
MATERIAL AND METHODS
We evaluated 162 DSD patients submitted to genital reconstruction between 1965 and 2014. All patients had clinical
and psychological support.Genital reconstruction was performed in 127 patients before puberty and in 35 adults. Sixty-
eight patients underwent feminizing genitoplasty and 94 masculinizing genitoplasty. Mean follow-up was 26 yrs (14 to
50) and mean age at last evaluation was 26 yrs (18 to 69). Morphological results, need for reoperation, patient’s
satisfaction and social aspects were evaluated according to age at surgery.
RESULTS
Masculinizing genitoplasty before two years of age resulted in better morphological results. Complications and
reoperations were more frequent in older patients (70% vs. 40%). Male patients’ satisfaction with surgical results was
present in 87%. All adult patients who underwent surgery after puberty would rather have surgery in infancy. Fifty-one
of 59 adult patients have adequate sexual intercourse.Feminizing genitoplasty had good and regular morphological
results in 97% of the patients Reoperations were necessary in 4 patients. Outcomes were similar for early and late
surgery. Fifteen of 22 adult patients are sexual active, 8 are married and 5 had offspring. None of these patients
regretted surgery in infancy.
CONCLUSIONS
Genital reconstruction in infancy had good outcomes in adult life and was preferable by patients.