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15551

Impact of Laparoscopy for Diagnosis and Treatment In DSD Patients

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Kimihiko Moriya, Takahiko Mitsui, Takeya Kitta, Michiko Nakamura, Yukiko Kanno, Masafumi Kon and Katsuya Nonomura, Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

Purpose

Recently laparoscopy has gained wide acceptance in pediatric urology However, reports of evaluation and management for large numbers of DSD patients are scarce. To clarify the impact of laparoscopy for DSD patients, we have evaluated our experience with diagnostic and therapeutic laparoscopy in DSD patients.

Patients and Methods

Since April 1992, 28 laparoscopic surgeries were performed in 23 DSD patients after chromosomal and hormonal analysis. Among them, while 10 were diagnostic laparoscopy including gonadal biopsy in 10 patients, 18 were therapeutic laparoscopy in 17 patients. The final diagnosis was 46XY DSD in 9, mixed gonadal dysgenesis (MGD) in 6, ovotesticular DSD in 4 and Turner syndrome in 4. Surgical procedures and complications were evaluated.

Results

Mean age at laparoscopic surgery was 8.4 years (range: 3.3 months to 21.1 yrs). Diagnostic laparoscopy was indicated in 4 with 46XY DSD, in 3 with MGD and 3 with ovotesticular DSD. In 4 cases with 46XY DSD, laparoscopic gonadal biopsy was undergone in 2 and inspection alone in 2. Bilateral open gonadectomy was performed in 3 who were assigned as female and open hysterectomy with bilateral orchiopexy in 1 who was assigned as male thereafter. Among 3 with MGD, open or laparoscopic gonadal biopsy was undergone in 1 each after laparoscopic inspection in 3. Unilateral or bilateral gonadectomy were subsequently indicated in 2. In 3 cases with ovotesticular DSD, gonadal pathology was diagnosed as testis/ovary in 1, testis/ovotestis in 1 and ovary/ovotestis in 1 form the laparoscopic inspection and gonadal biopsy. However, the final diagnoses were bilateral ovotestis in 2 and ovary/ovotestis in1. Therapeutic laparoscopy was performed in 5 with 46XY DSD, 4 with MGD, 4 with ovotesticular DSD and 4 with Turner syndrome. Surgical procedures were gonadectomy (bilateral in 11, unilateral in 3, partial in 2), hysterectomy in 2 and sigmoid vaginoplasty in 1 (includes multiple procedure). There was no severe perioperative complication including unexpected open conversion in any diagnostic or therapeutic laparoscopy. In 4 with multiple laparoscopic surgeries, no severe intra-abdominal adhesion which disturbed second or third laparoscopic surgery was observed.

Conclusion

Laparoscopic surgery was safe in various procedures in DSD patients. While diagnostic laparoscopy is helpful to make the therapeutic surgical strategy for most patients with DSD by confirming the anatomy of internal genital organ and gonadal pathology, attention should be paid to diagnose precise gonadal status in ovotesticular DSD despite the efforts of laparoscopic inspection and gonadal biopsy. On the other hand, therapeutic laparoscopic surgeries were valuable procedures to treat DSD patients.