Histrelin implantation in the pediatric population: A 10-year institutional experience.
PURPOSE
To perform the largest review of the safety and clinical management practices of histrelin implantation in children.


METHODS
A retrospective cohort study was performed including all patients (age ≤ 20) that underwent histrelin implant insertion, replacement, or removal by a single surgeon at a large pediatric tertiary care center (2008-2017). Data analyzed included patient demographics, procedure details, and complications.


RESULTS
A total of 377 patients, with a mean age of 9.3 ± 2.4 years, underwent 866 unique procedures (352 insertions, 329 replacements, and 185 removals) for a diagnosis of either central precocious puberty (343 patients, 821 cases) or gender identity disorder (34 patients, 45 cases). There were 271 (72%) female patients, 72 (19%) male patients, and 34 (9%) children in gender transition. Procedures were performed in three settings: 415 (47.9%) in the outpatient clinic, 401 (46.3%) in a sedation unit, and 50 (5.8%) in the operating room. The preferred setting shifted over time to more clinic-based procedures (9.4% vs. 62.9% in the first five vs. second five years, respectively). Complications were rare (1% of cases).


CONCLUSION
Histrelin implantation in the pediatric population is safe, with minimal morbidity. Implantation and removal in the clinic setting are appropriate for the majority of patients.


LEVEL OF EVIDENCE
Treatment study; Level IV.
['Swendiman|Robert A|RA|', 'Vogiatzi|Maria G|MG|', 'Alter|Craig A|CA|', 'Nance|Michael L|ML|']
D000554:Ambulatory Care Facilities D002648:Child D004343:Drug Implants D005260:Female D000068116:Gender Dysphoria D005783:Gender Identity D007987:Gonadotropin-Releasing Hormone D006801:Humans D008297:Male D009873:Operating Rooms D011629:Puberty, Precocious D012189:Retrospective Studies
Histrelin Implant Precocious puberty Gender dysphoria