[Role of laparoscopy in the management of the abnormalities of sex differentiation: about 12 cases]

Disorders of sex differentiation cause a discrepancy between sex itself (phenotype) and genetic sex (genotype) which poses a problem in sex determination. In lower socioeconomic level countries where prenatal diagnosis is often absent and technical equipments are inadequate, medical and surgical management is difficult. The aim of this study is to clarify the role of laparoscopy in the management of sexual ambiguity through observation of 4 cases and review of the literature.

[Conjoined twins at common omphalocele and cloacal exstrophy with sexual ambiguity]

Les jumeaux conjoints sont considérés comme étant une complication rare et grave des grossesses monozygotes. Le diagnostic anténatal permet de définir avec précision les structures communes, de rechercher une anomalie congénitale associée, d'organiser l´accouchement et la prise en charge néonatale. Nous présentons un cas rare de jumeaux conjoints dont la fusion se situait au niveau d'une omphalocèle commune associée à une extrophie cloacale, ambiguïté sexuelle et pieds bots. Le diagnostic a été méconnu pendant la grossesse, ce qui a engendré une dystocie lors de l'accouchement. L'issue a été fatale malgré une tentative de séparation et des mesures de réanimation. Ce cas illustre la difficulté liée d'une part à la méconnaissance du diagnostic, d'autre part au caractère urgent de la césarienne et de la séparation chirurgicale.

Managing disorder of sexual development surgically: A single center experience

INTRODUCTION

Ambiguous genitalia are a major cause of parental anxiety and create psychological and social problems to patient, if not managed properly. Here we present our experience in managing patients with ambiguous genitalia.

MATERIAL AND METHODS

We retrospectively reviewed clinical records of all patients with ambiguous genitalia managed surgically at out institute between December 1989 and January 2011. Relevant history, clinical examination, investigations and surgical procedures performed were analyzed and results were evaluated in terms of anatomical, functional and psychosexual outcomes.

RESULTS

Female pseudohermaphroditism was the most common cause of genital ambiguity in our patients. Male and female genitoplasty was done according to gender of rearing, genital anatomy and parental choice. Twenty six patients (86.6%) reported satisfactory cosmetic outcome and 22 (73.3%) satisfactory functional outcome on long term follow-up. Among the 24 patients diagnosed as male pseudohermaphroditism 14 (82.3%) patient have reported satisfactory cosmetic outcome and 13 (76.4%) have reported satisfactory functional outcome. In patients with mixed gonadal dysgenesis and true hermaphroditism satisfactory cosmetic and functional outcome was seen in 70% patient.

CONCLUSION

Managing patients of genital ambiguity according to gender of rearing, genital anatomy and parental choice carries good prognosis in terms of anatomical, functional and psychosexual outcome.