Division of Urology, Alfred I. duPont Hospital for Children, Wilmington, Delaware 19803, USA.
J Urol. 2011 Feb;185(2):393-400. doi: 10.1016/j.juro.2010.09.083. Epub 2010 Dec 17.
In 2005 medical and lay experts convened (the Chicago Consensus), and reviewed and updated nomenclature and treatment recommendations in individuals with congenitally atypical gonadal, chromosomal or anatomical gender. This review summarizes, analyzes and considers the implications of these recommendations in pediatric urology practice.
Publications identified in a PubMed® search of 2000 to 2010 as well as relevant prior reports of new concepts and trends in the diagnosis of and treatment for intersex/ambiguous genitalia/disorders of sex differentiation, and responses to the Chicago Consensus were reviewed.
In response to concerns regarding outdated, confusing and/or controversial terms, such as "intersex," "hermaphroditism" and "sex reversal," the consensus statement recommended a new taxonomy based on the umbrella term, "disorders of sex differentiation." Additional categorization based on sex chromosome complement was recommended but not clearly defined and variously interpreted. Routine use of multidisciplinary diagnostic and expert surgical teams, continuing psychosocial and psychosexual care, and full disclosure of alternatives relating to surgery type and timing were recommended. Early gender assignment was advocated but evidence-based guidance to support some aspects of care of affected individuals was insufficient. Pediatric urologists should remain abreast of new data refining the diagnoses and outcomes of disorders of sex differentiation, and ensure that their patients have access to multidisciplinary resources.
Major changes in classification and expectations in the care of individuals with disorders of sex differentiation have occurred in recent years. Increasing focus on determining precise etiology and defining objective outcomes will help more clearly determine appropriate management and prognosis for this heterogeneous group of disorders.
2005 年，医学和非医学专家召开了（芝加哥共识）会议，对具有先天性非典型性腺、染色体或解剖性别个体的命名法和治疗建议进行了回顾和更新。本综述总结、分析并考虑了这些建议对小儿泌尿外科实践的影响。
通过对 2000 年至 2010 年的 PubMed®检索，以及关于性发育障碍/两性畸形/性别分化障碍的诊断和治疗新概念和新趋势的相关报告，对出版物进行了回顾，对芝加哥共识的回应也进行了回顾。
针对过时、混淆和/或有争议的术语，如“两性畸形”、“两性人”和“性别反转”，共识声明建议采用一个新的分类法，基于“性别分化障碍”这一总括术语。还建议根据性染色体组成进行进一步分类，但没有明确界定，且有不同的解释。建议常规使用多学科诊断和专家手术团队，继续进行心理社会和心理性关怀，并充分披露与手术类型和时间相关的替代方案。提倡早期性别分配，但支持受影响个体护理某些方面的循证指导不足。小儿泌尿科医生应关注不断完善的性别分化障碍的诊断和结果的新数据，并确保其患者能够获得多学科资源。
近年来，在性别分化障碍患者的分类和护理期望方面发生了重大变化。越来越关注确定确切病因和定义客观结果将有助于更清楚地确定对这一异质性疾病组的适当管理和预后。
