Handbook of Clinical Gender Medicine. Группа авторов
Чтение книги онлайн.

Читать онлайн книгу Handbook of Clinical Gender Medicine - Группа авторов страница 28

Название: Handbook of Clinical Gender Medicine

Автор: Группа авторов

Издательство: Ingram

Жанр: Зарубежная психология

Серия:

isbn: 9783805599306

isbn:

СКАЧАТЬ androgen insensitivity syndrome, extreme forms of micropenis or PAIS with poor response to androgen stimulation, 5-α reductase deficiency, 17-hydroxysteroid dehydrogenase deficiency, LH receptor deficiency, and complete gonadal dysgenesis.

      This surgery includes three main steps. The first step involves creation of a vaginal conduit by connecting an existing müllerian cavity to the pelvic floor, or by dilating an existing vaginal cup, or by creating a penetrative conduit de novo. There is no consensus regarding the timing of this surgery. The second step consists of GT reduction which is also subject to controversies as this surgery may jeopardize GT sensitivity. A better understanding of the nerve distribution of the GT has led to major changes in the surgical procedures (a paradox of this surgery is that outcomes will be assessed many years in the future, when the patient becomes an adult). The third step is refashioning the perineal anatomy.

      Other procedures essentially include gonadal surgery and surgery of the müllerian remnants.

      The Gonads

      Uterine Remnants

      Removing uterine remnants is advisable when the male gender is assigned as they may start bleeding at puberty with the influence of aromatase conversion of steroid hormones. Removing utricular cavities is sometimes necessary if the patient becomes symptomatic (dysuria, urinary tract infection). This surgery is usually performed laparoscopically, with special attention to the vasa deferentia, which are often closely attached to the utricular walls.

      Results of Surgery

      Results of masculinization surgery are evaluated according to the cosmetic aspects of the reconstructed GT, and its function, in terms of both transurethral urinary flow and sexual performance. It therefore requires a very long follow-up, through childhood, puberty, and adulthood. It is actually very difficult to get an objective idea of the results of the surgery because patients’ views often differ from surgeons’ views. Urine flow studies are unreliable because the material used for replacing the deficient urethra is different from normal urethral walls and because patients who received urethral surgery, especially children, commonly have dys-synergic micturition for a long time postoperatively. The capacity of children to tolerate dysuria is remarkable, and it is enhanced by the fear of having to undergo another surgical operation. Absence of a urinary tract infection and complete bladder emptying, checked by ultrasound scans, with no deterioration of the whole urinary tract, are probably the most reassuring criteria to assess the outcome of these reconstructions. The reported results on sexual life after early surgery are scarce and subjective. Questions remain about the sensitivity of the glans after hypospadias or clitoral surgery [7]. The number of operations certainly affects the patient’s confidence to enter adult sexual life. Ejaculatory anomalies are variable between 6 and 37% of operated individuals. There is no convincing data on impaired fertility.

      Outcome of Micropenis

      Outcome of Phalloplasty

      Present data only concerns adult patients. A lot more detailed information concerning child and adolescent outcomes needs to be discovered in this very specific group.

      References