Читать книгу Handbook of Clinical Gender Medicine - Группа авторов - Страница 77

DSD surgery should be done by DSD surgeons, i.e. surgeons familiar with genital reconstruction in children. Hypospadias reconstruction is commonly performed between 6 months and 2 years of age and includes three main steps. The first step is full dissection of the GT to expose the level of division of the corpus spongiosum which is the proximal landmark of the GT anomaly. It is then possible to evaluate the quality of the tissues available and choose the most appropriate technique for urethroplasty. In the second step, the choice of urethroplasty is dependent upon the length of the urethra to reconstruct, the quality of the urethral plate, the size of the glans, and the availability of dorsal tissues. The third step consists of refashioning the ventral aspect of the GT by redistributing the tissues around the penis, with or without conservation of the foreskin. There is no universal technique for hypospadias repair and no gold standard technique. The outcome is dependent upon many factors, the most important of which is the experience of the surgical team and the quality of postoperative care.

Phalloplasty is even more challenging and has been imported from adult urological surgeons experienced with transsexual surgery. Experience and follow-up in children is extremely short and these procedures should be confined to one or two places on each continent. Main indications are represented by aphallia, a very small GT in males, or a damaged penis after exstrophy surgery [31].