XXXX : Current Surgical Management at Academic Medical Centers in the United States.

@entity1 @entity4998 @entity774
PURPOSE: Controversy exists on the necessity for and timing of genitoplasty in @entity1 with @entity774 . Our knowledge of surgical preferences is limited to retrospective series from single institutions and physician surveys, which suggest a high rate of early reconstruction. We evaluated current surgical treatment for @entity774 at academic centers. MATERIALS AND METHODS: We queried the Faculty Practice Solutions Center database to identify all female @entity1 younger than 18 years with a diagnosis of @entity774 between 2009 and 2012. Procedures were identified by CPT codes for vaginoplasty, clitoroplasty and other genital procedures. Reconstruction type, age at surgery and surgeon volume were analyzed. RESULTS: We identified 2,614 females in the database with a diagnosis of @entity774 who were seen at a total of 60 institutions. Of @entity1 younger than 12 months between 2009 and 2011 as few as 18% proceeded to surgery within a 1 to 4-year followup. Of those referred to a pediatric urologist 46% proceeded to surgery. Of @entity1 who underwent surgery before age 2 years clitoroplasty and vaginoplasty were performed in 73% and 89%, respectively, while 68% were treated with a combined procedure. A medium or high volume surgeon was involved in 63% of cases. CONCLUSIONS: Many @entity1 with @entity774 in the database did not proceed to early reconstructive surgery. Of those referred to surgeons, who were possibly the most virilized @entity1 , about half proceeded to early surgery and almost all underwent vaginoplasty as a component of surgery. About  two-thirds of the procedures were performed by medium or high volume surgeons, indicative of the surgical centralization of disorders of @entity4998 .
