Surgical complications in patients with Differences in Sexual Development (DDS) undergoing masculinizing genitoplasty

Abstract

Introduction: Differences in sexual development (DSD) are congenital conditions in which chromosomal, gonadal, or genital sex is atypical¹. The incidence of atypical genitalia is estimated at 1:4,500–5,500 births² and may result from either androgen excess or deficiency. Incomplete masculinization of male genitalia manifests as an underdeveloped penile shaft, curvature, and failure of urethral tubularization. In most DSD cases, the urethral meatus is located proximally on the penis, characterizing severe or complex hypospadias^3,4,5. Genital adequacy involves correcting this hypospadias, typically performed in two surgical stages. Postoperative complication (POC) rates are high, ranging from 8% to 56%^6,7,8, compromising long-term outcomes. Clinical factors such as phenotype, age at surgery, and surgical technique are associated with POC⁹. Objectives: To analyze, through an integrative literature review, DSD in patients undergoing masculinizing genitoplasty and the factors associated with complication rates. Methodology: Articles were selected from the PubMed, SciELO, Google Scholar, and MEDLINE databases using the keywords: Disorders of sexual development; Hypospadias; Postoperative Complication.. The review included articles indexed between 2014 and 2024, published in Portuguese or English. Results: The average POC rate was 57.12%, with higher incidence observed in cases of severe hypospadias. Advanced age at initial repair increased the probability of reoperation¹⁰, while success rates were lower for proximal urethral defects¹¹. The most frequent POCs included urethrocutaneous fistulas, abnormal meatal positioning, urethral stenosis, penile curvature, and abnormal urination¹². Age greater than two years at the time of the first surgery was a significant predictor of POC¹³. Discussion and conclusion of the results: Long-term follow-up is essential to assess the true incidence of POC, with age at the first operation playing a critical role. The most frequent complications are urethrocutaneous fistulas, urethral stenoses, and glandular dehiscence.