Society For Pediatric Urology

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Feminizing Genitoplasty in Patients with DSD: Evaluation of Long-term Surgical Results Regarding Genital Morphology and Sensibility, Complications, Sexual Function and Patient Satisfaction.
Min J. Bag, MD., Marlene Inacio, PhD, Tânia Bachega, MD., PhD, Sorahia Domenice, MD., PhD, Berenice B. Mendonça, MD., PhD, Francisco T. Dénes, MD., PhD, Maria Helena Sircili, MD., PhD.
Universidade Sao Paulo, Sao Paulo, Brazil.

Background: Atypical genitalia are common in patients with DSD and genitoplasty is part of their treatment. Reports of surgical results are dissimilar, especially concerning Feminizing Genitoplasty (FG), with few publications presenting late evaluation of genital sensibility and sexual function. The aim of this study is to evaluate the long-term results of DSD patients submitted to FG, regarding genital morphology and sensitivity, surgical complications, sexual function, as well as patient satisfaction with the procedure.
Patients and Methods: 59 DSD patients, being 36 due congenital adrenal hyperplasia (CAH) and 23 secondary to other etiologies (non-CAH), were submitted to FG that included simultaneous clitoral and urogenital sinus (UGS) repair in 48 cases, only clitoral surgery in 10 and only UGS repair in 1. The mean follow-up time was 13.8 ± 12 years. Patients were submitted to genital examination as well as quantitative sensorial testing and completed questionnaires about urinary continence, sexual function and satisfaction with FG. Clinical records were reviewed for postoperative complications. A control group was also evaluated regarding urinary continence, genital sensibility and sexual function. Results were analyzed in relation to age at surgery and surgical techniques. Associations between morphological and sensorial findings and sexual function were analyzed and compared with the control group.
Results: Postoperative complications were found in 17% cases of CAH and in 26% non-CAH patients. Clitoral size was adequate in 93% of patients, while in 4 the clitoris could not be found. Separate perineal orifices were found in 83% of CAH and in 88% of non-CAH patients. Those with persistent UGS did not present any symptom due to this condition. None of the patients had continuous urinary incontinence. The incidence of adult patients with sporadic urinary leakage was similar to that of the control group. Genital sensibility of CAH patients was comparable to that of the control group. Non-CAH patients had a less sensitive clitoris, but other clitoral sensorial thresholds were similar to those of the control group. There was no difference of sensibility in the vaginal margin between the patients’ and control groups. None of the CAH patients had sexual dysfunction; 3 non-CAH patients and 4 women of the control group had dysfunction with same affected domains. Most patients were satisfied with the late results of FG and confirmed that the procedure should be done during childhood and not in adulthood.
Conclusions: Surgical results are not influenced by age at FG. Genital sensibility is not affected by surgery. Sexual function in active patients is comparable to that of the control group. Patients are satisfied with the results of FG and also to have been operated early in life.

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