333- When should surgery for hypospadias be performed in a child with 46 , XY DSD?
In a child with 46,XY DSD and hypospadias, corrective surgery should ideally
be performed at 6–12 months of age. This is because gender identity of an indi-
vidual is established by 2–3 years of life, and, therefore, early genital surgery is
associated with better psychosocial and emotional outcome. Further, surgery
during this period has favorable outcome because of pliability of genital tissues,
reduced pro-infl ammatory cytokine response, and lesser surgical complica-
tions. Genital reconstruction surgery is usually performed as a one- stage proce-
dure. However, proximal hypospadias and coexisting chordee require a
two-stage repair.abcFig. 9.21 ( a , b ) An individual with OT-DSD who is reared as female. She underwent bilateral
gonadectomy and phallic resection during prepubertal period and is on estrogen replacement. ( c )
External genitalia showing normal female phenotype
9 Disorders of Sex Development