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Titolo:
The incidence of intersexuality in children with cryptorchidism and hypospadias: Stratification based on gonadal palpability and meatal position
Autore:
Kaefer, M; Diamond, D; Hendren, WH; Vemulapalli, S; Bauer, SB; Peters, CA; Atala, A; Retik, AB;
Indirizzi:
Childrens Hosp, Dept Urol, Boston, MA 02115 USA Childrens Hosp Boston MA USA 02115 Hosp, Dept Urol, Boston, MA 02115 USA Childrens Hosp, Dept Surg, Boston, MA 02115 USA Childrens Hosp Boston MA USA 02115 Hosp, Dept Surg, Boston, MA 02115 USA Harvard Univ, Sch Med, Boston, MA USA Harvard Univ Boston MA USAHarvard Univ, Sch Med, Boston, MA USA
Titolo Testata:
JOURNAL OF UROLOGY
fascicolo: 3, volume: 162, anno: 1999,
parte:, 2
pagine: 1003 - 1006
SICI:
0022-5347(199909)162:3<1003:TIOIIC>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
LEMLI-OPITZ SYNDROME; TESTICULAR DESCENT; DEFICIENCY; FLUTAMIDE; RAT;
Keywords:
abnormalities; intersexuality; cryptorchidism; hypospadias; feminization, testicular;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Kaefer, M Riley Childrens Hosp, 702 Barnhill Dr, Indianapolis, IN 46202 USA Riley Childrens Hosp 702 Barnhill Dr Indianapolis IN USA 46202 A
Citazione:
M. Kaefer et al., "The incidence of intersexuality in children with cryptorchidism and hypospadias: Stratification based on gonadal palpability and meatal position", J UROL, 162(3), 1999, pp. 1003-1006

Abstract

Purpose: The combined findings of cryptorchidism and hypospadias often indicate the existence of an intersex state. Testicular maldescent and incomplete tubularization of the urethral plate occur in a spectrum with the severity of the 2 processes likely dependent on the degree of pathophysiology inthe androgenic hormonal axis. The incidence of intersexuality in children with undescended testes, hypospadias and otherwise nonambiguous male genitalia has been reported to be 27%. Although the likelihood of genotypic or gonadal ambiguity has previously been associated with meatal position in thispopulation, to our knowledge our study is the first to evaluate the incidence of intersexuality relative to whether the undescended testis is palpable or nonpalpable. Materials and Methods: The database at our hospital was searched for all cases of undescended testes (2,105) and hypospadias (1,057) between 1982 and1996. Radiographic, histological and karyotypic data were compiled for allpatients presenting with both diagnoses. Gonadal palpability (palpable versus nonpalpable) and meatal position (anterior versus mid versus posterior)were recorded and correlated with the likelihood of identifying an intersex condition. Ten boys with a diagnosis of undescended testes subsequent to inguinal hernial repair were excluded from study. Patients with congenital adrenal hyperplasia or complete testicular feminization were also excluded from study due to the clearly female appearance of the external. genitalia. Statistical significance was assessed using Fisher's exact test. Results: We identified 79 patients presenting with undescended testes, hypospadias and a phallus that was believed to be a possible penis. Intersex conditions were identified with nearly equal frequency in the 44 eases of unilateral (30%) and 35 of bilateral (32%) cryptorchidism. In the unilateral undescended testes group patients with a nonpalpable testis were at least S-fold more likely to have an intersex condition than those with a palpable undescended testis (50 versus 15%, p = 0.02). In the bilateral group patients with 1 or more nonpalpable testes were also nearly 3-fold as likely to have an intersex condition than those with bilateral palpable undescended gonads (47 versus 16%, p = 0.07). Meatal. position was graded as anterior in 33% of cases, mid in 25% and posterior in 41% with the more posterior location conferring a significantly greater likelihood of an intersex condition (anterior 2 of 26, mid 1 of 20 and posterior 21 of 33). Conclusions: Gonadal palpability is an important predictor of an intersex state in unilateral and bilateral cases of cryptorchidism with hypospadias. Patients with an undescended testis that cannot be palpated are significantly more likely to have an intersex condition than those in whom the undescended testis may be palpated on physical examination. The severity of hypospadias likewise has a strong positive correlation with an intersex state.

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Documento generato il 04/12/20 alle ore 09:53:09