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PAEDIATRIC UROLOGY

10.4.1 Genitoplasty

Masculinizing genitoplasty incorporates the following stages:

  1. Androgenotherapy i.e. administration of TST. Its goal is to restore, if possible, a normal penile size, hence it should be used in the first months of life. Systemic or local TST can be administered (the latter mode involves the mother in the treatment).

  2. Excision of Mullerian duct structures: firstly because subsequent urethroplasty may cause urine retention and infection within an existing pseudocolpos, and secondly because casual discovery of a retained Mullerian structure later in life may question the patient's gender.

  3. Urethroplasty with release of chordee and correction of scrotal deformities. Orchidopexy of testes that are to be retained.

Feminizing genitoplasty in САН should be performed once the patient's general status, blood pressure and electrolyte balance have been stabilized by systemic steroid substitution. This is usually achieved around the second or third month of life. The family should be cautioned, however, that re-evaluation of the vaginal opening and possibly revision vaginoplasty may be needed at puberty.