Long-term 10-Year Comparison of Girls with Congenital Adrenal Hyperplasia Who Underwent Early and Late Feminizing Genitoplasty

Abstract

Abstract Objectives: The appropriate time to perform feminizing genitoplasty in patients with congenital adrenal hyperplasia (CAH) with the 46, XX genotype is still debatable. The aim of our study was to evaluate the relationship between age at surgery and surgical success in patients who had feminizing genitoplasty due to CAH in our clinic. Methods: Our clinic retrospectively analyzed 14 patients with CAH and 46, XX genotypes with feminizing genitoplasty (clitoroplasty + vaginoplasty) between 2005 and 2022. The patients were divided into two groups. The mean follow-up time was 10 years. Results: . Group 1 consisted of seven girls (n = 7/14) who has operations before the age of 2 years (mean 11.7 months). Group 2 consisted of seven girls (n = 7/14) who had operation after the age of 2 years (mean 53 months). There was no statistically significant difference between those operated on before and after two years in terms of anatomical assessments, overall cosmetic results and parent satisfaction except the need for additional intervention (P=0.049). When parent satisfaction was compared with additional surgical intervention, as expected, parents’ satisfaction increased as major surgical intervention decreased. This was statistically significant (p = 0.007). The main source of dissatisfaction was repeated surgery among the parents. Conclusions: The possibility of this additional surgical intervention increases, and patient satisfaction decreases in patients below the age of 2 years. The corrective surgeries can be deffered until the gender identity of the patient matures and the patient autonomy in deciding whether this surgery should occur.