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This book is the product of long years of close collaboration between two physicians, a pediatric endocrinologist and a pediatric surgeon, who are interested in the complex field of human malformations. Their efforts have set a new standard in the treatment of children with intersexual or mal formed female genitalia. It is impossible to convey the details of complex surgical procedures without the help of meticulous illustrations. It is fortunate that happened to meet an academically trained artist, Mrs. Siri Mills, M.A., while visiting in the United States. Her excellent knowledge of anatomy, her remarkable skills as an artist and technical illustrator, and her readiness to include all details of interest to the surgeon have found their fruitful expression in the illustrations of this book. We express our thanks to Springer-Verlag and especially to Prof. Diet rich Goetze, at whose suggestion this book was written, for their amiable compliance with all our wishes, and particularly for their willingness to retain Mrs. Mills as our illustrator. Munich, May 1985 WALDEMAR HECKER Contents In trod ucti on 1 Part 1 : Endocrinologic Diagnosis in Pediatric Patients with Genital Anomalies General Rules . . . . . . . . . . . 4 Endocrinology of Antenatal Sex Differentiation 6 Male Differentiation 6 Female Differentiation 7 Specific Endocrinologic Diagnosis and Therapy 8 Virilization of the Female External Genitalia 8 Congenital Adrenogenital Syndrome with a Defect of 21-Hydr- ylase . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Intersexual Genitals Due to Deficient Androgenization of the Male 11 Defects of Testosterone Biosynthesis 11 Androgen Receptor Defects . . .
List of contents
1: Endocrinologic Diagnosis in Pediatric Patients with Genital Anomalies.- General Rules.- Endocrinology of Antenatal Sex Differentiation.- Specific Endocrinologic Diagnosis and Therapy.- Intersexual Genitals Due to Deficient Androgenization of the Male.- Forms of Intersexuality Caused by Chromosomal Abnormalities.- Principal Endocrinologic, Genetic and Radiologic Examination Methods.- 2: Surgical Measures for the Correction of Intersexual Genitalia and Female Genital Malformations.- General Guidelines Regarding the Optimum Timing of Corrective Surgery and Studies Necessary for Preoperative Planning.- Correction of Clitoral Hypertrophy and Urogenital Sinus with Low Vaginal Entry.- Secondary Correction to Improve Glans Coverage.- Surgical Correction of Urogenital Sinus with High Vaginal Entry.- Procedure for Subtotal Vaginal Aplasia.- Correction of Hydrometrocolpos Secondary to Hymenal or Vaginal Atresia.- Synechia of the Labia Minora.- Hypertrophy of the Labia Minora.- Surgical Enlargement of Contracted Introitus.- Surgical Correction of Combined Urogenital and Anorectal Malformations (Cloacal Syndrome).- Correction of an Ectopic Anus in the Vestibular Fossa of the Vagina.- Correction of a Posteriorly Placed Urogenital Sinus or Vaginal Opening.- Straightening the Phallus.- Urethroplasty.- Implantation of Prosthetic Testes.- Meatotomy of Prader Type IV Intersexual Genitals Following a Pullthrough Vaginoplasty.- General Concluding Remarks.- References.
