Bilateral orchiectomy for the surgical treatment of complete androgen insensitivity syndrome: patient outcome after 1 year of follow-up.

Overview

OBJECTIVE: To describe an operative approach to bilateral orchiectomy for complete androgen insensitivity syndrome (AIS) and to report patient status 1 year after surgery. MATERIAL AND METHOD: A 19(1/2)-year-old woman with primary amenorrhea, cervical/uterine agenesis, elevated serum testosterone, and 46,XY karyotype underwent characterization of the androgen receptor mutation by polymorphism sequence analysis. Bilateral orchiectomy was performed via a triple-puncture 5-mm laparoscope, and postsurgical hormone replacement followed a daily oral contraceptive model. Psychological counseling was provided to the patient and her family. RESULTS: Minimally invasive removal of the gonads was accomplished without complication. Microscopic examination of the testes revealed a benign Sertoli cell-only pattern. After 1 year, the patient's level of functioning and psychosexual status were unchanged in comparison with before surgery. CONCLUSIONS: Patients with complete AIS should undergo postpubertal gonadectomy because of an increased risk for malignant transformation of the testicles, and this can be performed safely via small-caliber laparoscopy. Attention to psychological considerations in such patients is important to maximize long-term success.