Short-Term Impact of Newly Imposed Legal Restriction on DSD Surgery in Children in Germany

Author:

Schäfer Frank-Mattias12ORCID,Schwab-Eckhardt Benjamin1ORCID,Voß Egbert3,Schroth Michael4,Staudt Franz5,Stehr Maximilian1

Affiliation:

1. Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, 90419 Nürnberg, Germany

2. Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany

3. Department of Pediatric Endocrinology, Cnopfsche Kinderklinik, 90419 Nürnberg, Germany

4. Department of Pediatrics and Neonatology, Cnopfsche Kinderklinik, 90419 Nürnberg, Germany

5. Master in Ethics, 94036 Passau, Germany

Abstract

Background/Objectives: In recent years, changing paradigms, both culturally and scientifically, have fundamentally altered the approach to the treatment of children with Disorders of Sexual Development (DSD) prior to reaching the age of legal consent. In Germany, the situation changed with the introduction of legislation that includes a partial ban on DSD surgery in children in 2021. This study aims to analyze the impact of this legislation on clinical practice. Methods: From 2014 to 2024, all patients with DSD in our institution were included. The study group comprised all patients operated on after the legislation. All patients operated on before the legislation served as the control group. Karyotype, phenotype, resulting type of DSD, age at presentation and age at operation were recorded. Results: A total of 35 patients were included in this study, with 15 in the study group and 20 in the control group. The operation was authorized by the family court for all patients in the study group. A total of 46,XY patients with severe hypospadias and clinical aspect of intersexual outer genitalia were the largest proportion (25 patients, 71.4%). Nine patients (25.7%) were 46,XX girls with classical congenital adrenal hyperplasia (CAH) type. One patient (2.9%) showed a mixed gonadal dysgenesis. The mean age of the patients at first presentation in our institution was 10.7 months in the control group and 11.0 months in the study group. The mean age at operation was significantly higher in the study group (20.1 months) compared to the control group (15.1 months; p = 0.032, unpaired t-test). Conclusions: The introduction of the legislation with a partial ban of genital surgery in DSD children in Germany has led to a significant delay in surgery. Since the majority of the patients comprise severe hypospadias and 46,XX CAH patients, further amendments of the law are proposed to minimize potential harm.

Publisher

MDPI AG

Reference24 articles.

1. Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, and how?;Mouriquand;J. Pediatr. Urol.,2016

2. Lawson Wilkins Pediatric Endocrine Society/European Society for Paediatric Endocrinology Consensus, Consensus statement on management of intersex disorders;Hughes;J. Pediatr. Urol.,2006

3. Congenital Adrenal Hyperplasia;Fraga;Pediatr. Rev.,2024

4. Congenital adrenal hyperplasia patient perception of ‘disorders of sex development’ nomenclature;Lekarev;Int. J. Pediatr. Endocrinol.,2015

5. Variations of sex development: The first German interdisciplinary consensus paper;Krege;J. Pediatr. Urol.,2019

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3