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Alderson J, Hamblin R, Kovell R. Psychosexual functioning and mental health and psychological considerations in adult patients with congenital urologic issues. J Pediatr Urol 2023:S1477-5131(23)00442-4. [PMID: 38782682 DOI: 10.1016/j.jpurol.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/30/2023] [Indexed: 05/25/2024]
Affiliation(s)
- Julie Alderson
- D. Clin. Psychol., Psychological Health Services, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Rachel Hamblin
- D. Clin. Psychol., Psychological Health Services, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Robert Kovell
- University of Pennsylvania, Perelman School of Medicine and Children's Hospital of Philadelphia, UK.
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Zhanghuang C, Long N, Yang Z, Xie Y. Bilateral adrenal giant medullary lipoma combined with disorders of sex development: a rare case report and literature review. Front Oncol 2023; 13:1210679. [PMID: 37681022 PMCID: PMC10482419 DOI: 10.3389/fonc.2023.1210679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Bilateral adrenal myelolipoma is rare in clinics and patients with disorders of sex development (DSDs). One case was reported in our center. A 45-year-old patient was admitted to the hospital after discovering a left abdominal mass for more than a year and worsening abdominal pain for 18 days. An imaging examination showed bilateral adrenal masses. Physical examination showed clitoris hypertrophy with patelliform changes, thick and dense pubic hair, normal development of bilateral labia majora without labia minora, and urethral opening. After the relevant preoperative examinations, bilateral adrenal mass resection was performed under general anesthesia. The postoperative pathology confirmed adrenal myelolipoma. The incision healed well without recurrence over 10 years after the operation. Her enlarged clitoris decreased in size. This case report has a detailed diagnosis and treatment process and sufficient examination results. It can provide a reference for diagnosing and treating patients with bilateral adrenal myelolipoma and DSD and reduce the risk of misdiagnosis and mistreatment.
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Affiliation(s)
- Chenghao Zhanghuang
- Department of Urology, Kunming Children’s Hospital, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
- Yunnan Key Laboratory of Children’s Major Disease Research, Yunnan Clinical Medical Center for Pediatric Diseases, Kunming Children’s Hospital, Kunming, China
| | - Na Long
- Special Ward, Kunming Children’s Hospital, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Zhen Yang
- Department of Oncology, Yunnan Children Solid Tumor Treatment Center, Kunming Children’s Hospital, Kunming, China
| | - Yucheng Xie
- Department of Pathology, Kunming Children’s Hospital, Kunming, China
- Department of Pathology, The Second People’s Hospital of Yunnan Province, Kunming, China
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Alderson J, Skae M, Crowne EC. Why do parents recommend clitoral surgery? Parental perception of the necessity, benefit, and cost of early childhood clitoral surgery for congenital adrenal hyperplasia (CAH). Int J Impot Res 2023; 35:56-60. [PMID: 35672389 DOI: 10.1038/s41443-022-00578-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 11/09/2022]
Abstract
Historically, medical management of Congenital Adrenal Hyperplasia (CAH) in girls typically involved feminising surgery, which meant reducing the size and/or visibility of the enlarged clitoris. This practice may have become less routine but remains a common response to genital differences associated with CAH. Parents typically give permission for the child to undergo surgery in early childhood and recommend other parents facing a similar situation do the same. The current report is based on a qualitative content analysis of interviews with sixteen parents whose daughters with CAH had undergone one of two forms of clitoral surgery. We observed that: (i) some parents were initially unconcerned about their child's genital presentation; (ii) in general, clitoral surgery was considered as a readily available and natural response to the child's bodily difference; (iii) the parents acknowledged that there would be some risk but anticipated various benefits; and (iv) there was an absence of ethical considerations when the parents evaluated the various effects of surgery afterwards. We conclude from our analysis that parents of girls with CAH may not receive psychologically and ethically informed counselling to encourage critical reflections prior to authorizing genital surgery.
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Affiliation(s)
- Julie Alderson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Mars Skae
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Elizabeth C Crowne
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Meyer-Bahlburg HFL. The Timing of Genital Surgery in Somatic Intersexuality: Surveys of Patients' Preferences. Horm Res Paediatr 2022; 95:12-20. [PMID: 35045418 DOI: 10.1159/000521958] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
In recent years, intersex advocates, medical ethicists, and lawmakers have increasingly demanded a delay of genital surgery that is not acutely medically necessary in patients with somatic intersexuality to the age of consent. This study provides a review of published surveys of affected patients' own opinions on this issue. In part with search of PubMed 2000-2021, 10 pertinent surveys of patients were identified: 3 from the USA; 4 from European countries; and one each from Brazil, China, and Malaysia. All were based on samples of clinic patients, most of whom had previously undergone genital surgery. The majority of both XX and XY patients with somatic intersexuality favored early surgery, with somewhat more syndrome-specific variability in XY patients. The available survey data clearly indicate that a mandatory delay of genital surgery in all patients with somatic intersexuality to the age of consent would disregard the wishes of the majority of surveyed patients. A syndrome- and syndrome severity-specific individualized approach to surgery decisions appears more appropriate.
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Affiliation(s)
- Heino F L Meyer-Bahlburg
- New York State Psychiatric Institute, and Department of Psychiatry, Vagelos College of Physicians & Surgeons of Columbia University, New York, New York, USA
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Ulusoy O, Sabuncu S, Karakuş OZ, Ateş O, Hakgüder G, Olguner M, Akgür FM. Urinary continence after high urogenital sinus repair conducted with posterior prone approach: electromyography-uroflowmetric assessment. Int Urol Nephrol 2021; 53:1813-1818. [PMID: 34037908 DOI: 10.1007/s11255-021-02895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to present the results of urinary continence assessment objectively with electromyography (EMG)-uroflowmetry after high urogenital sinus (HUGS) repair with posterior prone approach without division of rectum. METHODS The records of patients who underwent HUGS repair via posterior prone approach between January 2005 and July 2018 were reviewed retrospectively. Incontinence, dysuria, hesitation, and straining during urination were evaluated during the clinical follow-up. Dysfunctional voiding scoring system was used as a questionnaire. Patients were re-evaluated with EMG-uroflowmetry in terms of voiding volume and pattern, voiding time, maximum flow rate, average flow rate, maximum flow time, and post-voiding residual volume. RESULTS Seven patients with HUGS were treated with a posterior prone approach. The median age of the patients was 18 months (8-21 months). The median UGS length was 4.4 cm (3.6-5.5 cm), urethral length was 1.1 cm (1.0-1.5 cm), and vaginal length was 4.9 cm (4.1-5.1 cm). No urination or defecation problems were described by the patients or their parents. When the results of the dysfunctional voiding scoring systems questionnaire were analyzed, results scored 7 (range 5-8). EMG-uroflowmetric test graphics of the patients showed normal flow curves without plateau, intermittency or irregularity. Pelvic EMG assessment was normal in all patients. CONCLUSION EMG-uroflowmetry has shown objectively that urinary continence and normal voiding pattern are preserved after HUGS repair with posterior prone approach without division of rectum.
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Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey.
| | - Serra Sabuncu
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Osman Zeki Karakuş
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
- Division of Pediatric Urology, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
- Division of Pediatric Urology, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
- Division of Pediatric Urology, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
- Division of Pediatric Urology, Faculty of Medicine, Dokuz Eylul University, 35340, Balcova, Izmir, Turkey
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Miolski J, Ješić M, Zdravković V. Congenital adrenal hyperplasia. MEDICINSKI PODMLADAK 2021. [DOI: 10.5937/mp72-31347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Congenital adrenal hyperplasia is a disease in which a gene mutation, which is inherited in an autosomal recessive manner, causes a disorder in the synthesis of enzymes that create glucocorticoids, mineralocorticoids, or sex steroids from adrenal cholesterol. The incidence of the classic form of the disease ranges from 1:14000 to 1:18000 births. In the majority of cases, the disease is caused by mutations in the CYP21A2 gene that participates in the synthesis of the 21 Alpha-hydroxylase. Due to the lack of enzymes, the synthesis of cortisol is blocked with the accumulation of sex hormones. The classic form of the disease, or a simple virilizing form in which patients lose salt, is diagnosed in the infant period. In the non-classical or mild form of the disease, with late-onset, patients may be asymptomatic or with a milder form of virilization postnatally. The diagnosis is made based on 17-hydroxyprogesterone levels, in order to determine the deficiency of the 21 Alpha-hydroxylase enzyme. Common complications of the disease are adrenal crisis, hypoglycemia, infertility, and premature entry into puberty. Prenatal therapy is referred to as experimental treatment, while the basis of care is hydrocortisone replacement. In severe forms of the disease, patients are unable to produce enough cortisol in response to stress from gastroenteritis, surgery, trauma, or fever, requiring higher doses of hydrocortisone. In certain cases of genital uncertainty, surgical treatment is necessary. A multidisciplinary team of experts is necessary for adequate surveillance of the disease, in both childhood and adulthood.
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