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EDITORIAL |
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| Year : 2005 | Volume
: 10
| Issue : 4 | Page : 215-216 |
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Intersex disorders and hypospadiology - A recent global hype
DK Gupta
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110 029, India
Correspondence Address:
D K Gupta
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9261.19270
How to cite this article:
Gupta D K. Intersex disorders and hypospadiology - A recent global hype. J Indian Assoc Pediatr Surg 2005;10:215-6 |
During this year, few notable International meetings related to Intersex and Hypospadias have been held in Saudi Arab, Abu Dhabi, Turkey, USA and Egypt, bringing together the experts from the world over. The distribution of Intersex cases has been found worldwide with the known higher incidence in the Middle East, Egypt, Turkey and India possibly due to practice of consanguinity. Interestingly, a higher incidence in hypospadias (1:125) was also recently proposed from USA. This may possibly be due to the recognition of milder forms that were left untreated previously, growing general awareness and the media publicity including the radio announcements by social organizations. Asian countries being more populous have a majority of the share with India being highlighted at the world scenario. There has been a general consensus on the trends being followed in various parts of the world depending upon the age at presentation and socio-economic and cultural issues.
The 1st World Congress on Hypospadias and Intersex Disorders was recently held in Istanbul from November 17-19, 2005 under the auspices of the International Society on Hypospadias and Intersex Disorders (ISHID). Dr. Seref Etker was the organizing chairman. The aim was to promote a better understanding, focusing on hypospadias and intersex disorders, through a world-wide collaboration of scientists, surgeons, physicians, patients and their families. More than 200 experts joined from all over the world to share their views at an international forum.
The highlights of the conference included two big round table conferences one on each day on intersex disorders and on hypospadias. For "Problems and perspectives in intersex" the panelists were D.K. Gupta, H. Ozbey, G. Koptagel-Ilal, P. E. D. Mouriquand, M. Nicolino and P.G. Ransley. A global need for long term follow up and psychosocial issues was realized. The consensus meeting held recently in Chicago was also discussed and the issues to touch the genitalia at younger age were deliberated. Though, there was no consensus on this subject, the opinions varied greatly from the west to the east. Divergent opinions were expressed that an intersex problem which may be managed conservatively in an open society (like in the West), may have to be dealt with urgency, including the surgery at an early age, to achieve near normal cosmesis in most conservative societies. Also the long term results on patients with CAH presented from India support this view. The CAH patients are well adjusted after puberty. The cosmetic results following genital surgery in infancy have also been quite satisfactory, both to the parents and the patients.
The panelists for "Controversy in hypospadias" included G.A. Manzoni, H.S. Asopa, W. Snodgrass, A. Bracka, P.D.E. Mouriquand, J.L. Pippi-Salle and P.G. Ransley. There was drift to perform the surgery at a younger age, Dr Snodgrass mentioning to perform surgery as early as 3-6 months in his personal practice. Others preferred to operate in infancy. However, most surgeons agreed on the difficulty experienced in operating on toddlers at 2-4 years and preferred to avoid this age.
There were ten plenary lectures during the world congress. Prof. D.K. Gupta (New Delhi) highlighted "Intersex disorders in children - A paradigm shift in Indian Scenario (1980-2005)" M. Nicolino (Lyon) delivered a plenary talk on "The biology and endocrinology of intersex". Prof H.S. Asopa (Agra) delivered two talks on "The evolution and current concepts in the management of hypospadias and intersex disorders" and "Concept of 'Asopa repair': its evolution and significance in contemporary management of hypospadias". P.G. Ransley (London) talked on "Reflection on intersex" while Ms. G. Koptagel-Ilal (Istanbul) covered the "Psychosocial aspects of gender identity disorders". J. L. Pippi Salle (Toronto) delivered a lecture on "Technical details to improve outcome in hypospadias repair" and P.D.E. Mouriquand spoke on "Surgery of ambiguous genitalia: Where do we stand in 2005?".
In the field of hypospadiology, it seemed there has been a drastic shift to adopt the Snodgrass 'TIP repair' for single stage procedures and Bracka repair for 2 stage repairs. W. Snodgrass (Dallas) gave a talk on "Hypospadias repair: The flapless future" while A.Bracka (Birmingham) talked on the "The changing role of 2-stage hypospadias repair".
Similar concerns were shown during the recent meeting during the Pediatric Surgery Update held in, Abu Dhabi during the UAE Pediatric Surgical Association with a special section devoted to Intersex disorders with lectures delivered by DK Gupta (New Delhi), N Dessouky (Egypt) and Y Gamal (Saudi Arabia).
In the following year, many national and International workshops are due; in Bangladesh, Lucknow, Delhi, Toronto, Kosovo, Germany, Cape Town, Romania and many more. It is encouraging that in the 21st century due attention is being paid to understand and teach the complex genital anomalies with the participation of like minded experts from all over the world meeting at common platforms.
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