Long-Term Outcomes of Interventions for Reproductive Dysfunction

项目摘要/摘要 是否通过手术“矫正”幼儿不明确的生殖器是儿科医学的一个领域。 这极具争议性。不理想的结果，如美容不良和性功能障碍 过时的手术程序在医学界引发了激烈的争论，争论的焦点是如何或是否， 外科手术应用于治疗生殖器不清的儿童。帮助解决这个问题 辩论，一项对当前手术程序的长期结果的前瞻性研究，包括并发症发生率 在接受男性化或女性化的个人中，需要与这些程序相关的 儿童早期的外科手术。此外，对决定继续或不继续这样做的父母的研究 为他们年幼的孩子做手术是必要的，以了解这些有争议的决定是如何影响父母的 对孩子的反应。最后，更好地理解认知、行为和社会发展 出生时生殖器不明确的儿童，包括识别用于预测性别的新标记 发展，是需要的。这项建议的总体目标是评估现代外科手术的结果。 考虑到受影响儿童及其父母的心理后果的技术。这 对于医生来说，信息是至关重要的，以便为父母提供指导，指导他们如何采取最佳的治疗方法 处理幼儿不明确的生殖器，包括没有手术是最好的可能性。这个 拟议研究中包括的临床医生和研究人员组成的跨学科小组涵盖了以下领域 心理学、统计学、儿科内分泌学和儿科泌尿科。我们小组的集体经历 优化我们及时将拟议研究结果转化为临床环境的能力。

PROJECT SUMMARY/ABSTRACT Whether or not to surgically “correct” ambiguous genitalia in young children is an area of pediatric medicine that is highly controversial. Suboptimal outcomes such as poor cosmesis and sexual dysfunction following outdated surgical procedures have driven intense controversy in the medical community over how, or if, surgery should be used in the treatment of young children with ambiguous genitalia. To help resolve this debate, a prospective study of long-term outcomes of current surgical procedures, including complication rates associated with these procedures, is needed among individuals who receive masculinizing or feminizing surgery during early childhood. Additionally, studies of parents who decide to proceed, or not, with such surgeries for their young child are necessary to understand how these controversial decisions impact parents’ reactions to their child. Finally, better understanding of cognitive, behavioral, and social development in children born with ambiguous genitalia, including identification of novel markers for predicting gender development, is needed. The overall goal of this proposal is to assess the outcomes of modern surgical techniques with a consideration of the psychological outcomes of affected children and their parents. This information is crucial for physicians to provide guidance to parents regarding the optimal approach for the management of ambiguous genitalia in young children, including the possibility that no surgery is best. The interdisciplinary group of clinicians and researchers included in the proposed studies span the fields of psychology, statistics, pediatric endocrinology, and pediatric urology. The collective experience of our group optimizes our ability to translate findings from the proposed studies to a clinical setting in a timely manner.