The choice of feminizing genitoplasty tactic in girls with congenital adrenal hyperplasya

Abstract

The choice of tactics for feminizing plastic surgery (one- or two-stage) remains an actually issue. To operate early, in the first months of a child’s life, when endocrinological stabilization is achieved, or to postpone the intervention until puberty? Despite the large number of approaches to surgical treatment, still not all results can be recognized as positive. There are complications that affect the quality of life of patients, not only of a surgical but also of a psychological nature. The advantages of one or another approach are currently impossible to prove, since this will require a prospective multicenter multidisciplinary study of long-term results with each of the approaches. Therefore, pediatric surgeons for a long time in the choice of tactics will be based on accumulated experience and logical reasoning. Given the extensive experience of multidisciplinary rehabilitation, the positive long-term results of two-stage feminization remains the preferred tactic for surgical treatment of girls with CAH. The increased risk of complications from the genitourinary system in the form of infections of the urinary tract, hematocolpos and hematometra in girls with a narrow common urogenital canal, which is inherent in virilization of 3, 4 and 5 degrees according to Prader, can be considered as a reason for an early one-stage feminizing plasty.