LAPAROSCOPIC HYSTERECTOMY IN A CASE OF MALE PSEUDOHERMAPHRODITISM WITH PERSISTENT MULLERIAN DUCT DERIVATIVES

We describe laparoscopic diagnosis and treatment for a case of dysgene tic male pseudohermaphroditism with persistent Mullerian ducts. The pa tient, a 32 year old man, with a history of surgery for hypospadias an d cryptorchidism during childhood, was referred because of anejaculati on. He was of short stature, with male external genitalia composed of a small penis and hypoplastic testis (1 ml right, 6 ml left side). Pla sma follicle stimulating hormone (FSH) was high (17 mUI/ml), testoster one low (1.9 ng/ml), and his karyotype was 46,XY. Pelvic ultrasound, n uclear magnetic resonance (NMR) and genitography disclosed a uterine-l ike structure with cavity communicating with the urethra. Laparoscopy and urethrocystoscopy confirmed the presence of a 4 cm uterus, which w as removed endoscopically at the same time. A biopsy of the left gonad was also performed. The uterus contained endometrial tissue and was f ibrotic. Histology of the left gonad showed spermatocytic arrest. We d iagnosed dysgenetic male pseudohermaphroditism. Laparoscopy, in our op inion, is an optimal tool to diagnose and treat abnormal sexual condit ions.