Pourquoi le diagnostic d’ambiguïté sexuelle constitue-t-il une urgence ? Analyse et réflexion à propos de deux observations

L’ambiguïté sexuelle est une urgence médicochirurgicale en raison du risque vital en période néonatale et de ces conséquences psychologiques qu’elle entraîne chez les parents et les enfants devenus adultes. Il convient poser très précocement le diagnostic afin d’assigner un sexe qui puisse permettre à l’enfant de vivre plus tard son identité. Les ambiguïtés sexuelles posent cependant de véritables problèmes psycho sociales lorsque le diagnostic n’est pas fait tôt ou lorsque ce diagnostic est erroné. Nous rapportons 2 cas d’ambiguïté sexuelle (1 cas de pseudohermaphrodisme féminin élevé en garçon et un cas de syndrome de Turner élevé en fille) afin d’identifier les problèmes posés par un diagnostic tardif ou erroné, de ressortir les difficultés de la prise en charge ultérieure en cas d’erreur diagnostic ou de diagnostic tardif et d’identifier la responsabilité de chaque maillon de la prise en charge. Mots clés : Ambiguïté sexuelle, urgence, Togo.The intersex disorder is a medico surgical emergency because of the vital risk in newborn period and of these psychological consequences that it drags in parents and children become adults. It agrees to put the diagnosis very precociously in order to assign a sex that can allow the child to live his/her identity later. The intersex disorders put however real psycho social problems when the diagnosis is not made early or when this diagnosis is erroneous. We report 2 cases of intersex disorders (1 female pseudo hermaphrodite raised in boy and an elevated Turner syndrome case in girl) in order to identify the problems of a belated or erroneous diagnosis, to take out again the difficulties of the ulterior management in case of mistake diagnosis or belated diagnosis and to identify the responsibility of every link of the management.Key words: Intersex disorders, emergency, Togo

Les Resultats De L\'orchidopexie Indiquee Dans Le Traitement Chirurgical De La Cryptorchidie Chez L\'enfant : A Propos De 120 Cas Colligés Dans Le Service De Chirurgie Pédiatrique Du Centre Hospitalier Universitaire de Treichville, Cote d\'Ivoire.

Les auteurs rapportent une étude rétrospective à propos des dossiers de 120 enfants âgés de sexe masculin de 0 à 15 ans, opérés en 15 ans pour cryptorchidie. La cryptorchidie était unilatérale droite dans 59 cas (49 %), gauche dans 43 cas (36 %) et bilatérale dans 18 cas (15 %). Les testicules étaient palpables 126 fois et non palpables dans 12 cas. Sur ces 12 patients présentant une localisation abdominale, 4 patients (33 %) avaient une cryptorchidie bilatérale et 8 (67 %), une localisation unilatérale. La technique opératoire utilisée était l\'abaissement testiculaire avec fixation du testicule entre la peau et le dartos. Cinquante trois patients (44 %) étaient opérés entre 2 et 3 ans d\'âge. L\'abaissement en un temps a été effectué fait chez 117 patients (97,5 %) et en deux temps chez 3 patients (2,5 %). Le testicule était situé à l\'orifice inguinal externe dans 51 cas (42,5 %), dans le canal inguinal dans 42 cas (35 %), à l\'orifice inguinal interne dans 15 cas (12,5 %) et abdominal dans 12 cas (10 %). Dix patients (8,3 %) présentaient une absence de fusion épididymo-testiculaire, 9 patients (7,5 %) une atrophie testiculaire. Quatre vingt seize patients (80 %) avaient un processus péritonéo-vaginal perméable, 3 patients (2,5 %), un cordon spermatique court, 1 patient (0,85 %) avec testicule évanescent, 1 patient (0,85 %) avec testicule dysplasique. Sur 138 testicules abaissés 14, sont remontés (10 %). L\'abaissement testiculaire avec orchidopexie entre le dartos et la peau donne des résultats satisfaisants, aussi bien à court, moyen et long terme. Les auteurs recommandent l\'orchidopexie à environ 2 ans d\'âge.This is a retrospective study of 120 children treated for cryptorchidism during a 15 year period. Cryptorchidism was located on the right side in 59 patients (49%), left in 43 (36%) and bilateral in18 (15%). The testes were palpable in 126 patients and non- palpable in 12. Amongst the 12 patients with abdominal cryptorchidism, 4 had both testes affected, and in 8, only one was affected. The surgical technique used was lowering and fixing the testes between the scrotal and dartos fascias. Fifty three patients (44%), were operated within the 2 to 3 years age group. One stage orchidopexy was done in 117 patients (97.5%), and two stage in 3 patients (2.5%). The testes were located at the external inguinal ring in 51 patients (42.5%), inside the inguinal canal in 42 (35%), at the internal inguinal ring in 15 (12.5%), and abdominal in 12 (10%). Ten patients (8.3 %) had no epididymo-testicular adhesion, and 9 (7.5 %) had testicular atrophy. Ninety six (80 %) patients had patent processus vaginalis, 3 (2.5 %) a short spermatic cord, 1 (0.85 %) evanescent testes, and in 1 (0.85 %) the testes were dysplasic. Amongst the 138 testes which underwent orchidopexy, 14 (10%) ascended back. Lowering of the testes with orchidopexy between the scrotal and dartos fascias gives good results at short, mid, and long term. The authors thus recommend orchidopexy in children at two years of age. Keywords: Orchidopexy- Children - Cryptorchidism.Clinics in Mother and Child Health Vol. 4 (2) 2007 pp. 711-71

Transfer of surgical competences in the treatment of intersex disorders in Togo

Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo. Results: There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French- speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. Conclusion: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities

The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa

Background: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA) and set the debate at the level of the humanist thinking in medicine. Patients and Methods: This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons′ directory was used to identify paediatric surgeons in the Francophone′s countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. Results: A total of 41 paediatric surgeons (68.33%) responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%), scholarship from a non-governmental organisations in 14 (34.15%) and self-sponsorships in 20 (48.78%). The average salary was 450 Euros (€) (range: 120-1 400 Euros). Most of the paediatric surgeons (68.29%) had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80%) had no subscription to specialised scientific journals. Conclusion: The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences