Laparoscopic Gonadectomy with Interval Reduction Clitoroplasty: A Feminizing Sexual Reassignment Approach for a Male Pseudohermaphrodite with Mixed Gonadal Dysgenesis, The First in the Philippines

Laparoscopic Gonadectomy with Interval Reduction Clitoroplasty: A Feminizing Sexual Reassignment Approach for a Male Pseudohermaphrodite with Mixed Gonadal Dysgenesis, The First in the Philippines
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Title:Laparoscopic Gonadectomy with Interval Reduction Clitoroplasty: A Feminizing Sexual Reassignment Approach for a Male Pseudohermaphrodite with Mixed Gonadal Dysgenesis, The First in the Philippines
Author/Abstract:
Arturo P. Castro Jr., MD and Jose Dante P. Dator, MD

Department of Urology, National Kidney and Transplant Institute

The problem of ambiguous genitalia on a medical point of view is rare but a complex one. It involves elaborate diagnostics and a multidisciplinary approach to treatment. This paper aims to instill awareness among physicians about the existence of these sexual differentiation disorders and to highlight the use of laparoscopy in the diagnosis and treatment of intersex cases. We present the case of a 2 5/6 year old child with ambiguous genitalia without palpable gonads. Work up revealed a 46 XY karyotype, testosterone levels consistent with a prepubertal male, and normal female pelvic ultrasound findings. MRI however, showed possible gonadal tissue in the right abdominal region. Cystoscopy, genitoscopy with genitogram and laparoscopic gonadectomy were performed. Intraoperative findings were an intraabdominal testis on the right and a streak gonad on the left. A persistent mullerian duct derivative was also noted. These findings confirm the diagnosis of male pseudohermaphroditism with mixed gonadal dysgenesis. She subsequently underwent a reduction clitoroplasty hence, completing the feminizing approach employed in resolving the patient's intersex problem.

Key words: male pseudohermaphroditism, mixed gonadal dysgenesis, laparoscopic gonadectomy, reduction clitoroplasty
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