Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
Department of Medical Psychology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
BJU Int. 2022 Mar;129(3):394-405. doi: 10.1111/bju.15369. Epub 2021 Mar 31.
To report the long-term follow-up outcomes of masculinizing surgery in disorders/differences of sex development (DSD), including both physicians' and patients' perspectives on appearance and functional outcome, including sexuality.
In total, 1040 adolescents (age ≥16 years) and adults with a DSD took part in this multicentre cross-sectional clinical study in six European countries in 2014/2015. Of those, 150 living in other than the female gender had some kind of masculinizing surgery: hypospadias repair, orchidopexy, breast reduction and/or gonadectomy. The study protocol included medical data collection, an optional genital examination, and patient-reported outcomes including satisfaction with appearance and current sexual functioning.
Diagnoses included partial and mixed gonadal dysgenesis (45,XO/46,XY; n = 38), Klinefelter syndrome/46,XX males (n = 57), and various 46,XY DSDs (n = 42; e.g. partial androgen insensitivity syndrome, severe hypospadias) and 13 with other diagnoses. Of the participants, 84 underwent hypospadias surgery, 86 orchidopexy, 52 gonadectomy and 32 breast reduction (combinations possible). Physicians evaluated anatomical appearance at genital examination as poor in approximately 11% of patients. After hypospadias surgery, 38% of participants reported that they were (very) dissatisfied with anatomical appearance and 20% with function. The physician and patient evaluations were moderately correlated (r = 0.43).
The majority of participants were neutral to satisfied with the appearance and function in the long-term after masculinizing surgery. Given the initial severe phenotype and a risk of unsatisfactory results after masculinizing surgery in DSD, treatment should be handled by experienced multidisciplinary teams in order to optimize the postoperative results.
报告性别发育障碍（DSD）患者接受男性化手术的长期随访结果，包括医生和患者对外观和功能结局（包括性）的看法。
共有 1040 名患有 DSD 的青少年（年龄≥16 岁）和成年人参加了这项 2014-2015 年在欧洲六个国家进行的多中心横断面临床研究。其中，150 名生活在女性以外性别的人接受了某种男性化手术：尿道下裂修复术、睾丸固定术、乳房缩小术和/或性腺切除术。研究方案包括收集医学数据、选择性生殖器检查以及患者报告的结果，包括对外观和当前性功能的满意度。
诊断包括部分和混合性腺发育不全（45,XO/46,XY；n=38）、Klinefelter 综合征/46,XX 男性（n=57）和各种 46,XY DSD（n=42；例如部分雄激素不敏感综合征、严重尿道下裂）和其他 13 种诊断。参与者中，84 人接受了尿道下裂手术，86 人接受了睾丸固定术，52 人接受了性腺切除术，32 人接受了乳房缩小术（可组合）。医生在生殖器检查中评估解剖学外观时，约 11%的患者表现不佳。尿道下裂手术后，38%的患者报告对解剖学外观（非常）不满意，20%对功能不满意。医生和患者的评估呈中度相关（r=0.43）。
大多数患者对男性化手术后的外观和功能在长期内保持中立或满意。鉴于 DSD 患者的初始严重表型和男性化手术后结果不满意的风险，应由经验丰富的多学科团队进行治疗，以优化术后结果。
