Gonadal morphology in cloacal exstrophy: implications in gender assignment

Objective. To compare the histology of gonads excised from males with cloac al exstrophy (the most severe variant of the exstrophy-epispadias complex) undergoing early gonadectomy and gender reassignment (to obviate difficulti es in reconstructing male external genitalia) with those published previous ly. Patients and methods. Testicular tissue was obtained from males with cloaca l exstrophy undergoing gender reassignment shortly after birth. Slides were stained for histological evaluation and reviewed by one author. The histol ogy was compared with known normal features for newborn testicular tissue. The mean age at the time of gender reassignment was 6 months. Results. There were no significant abnormalities in the architecture of the rete testis, epididymis or vas of the study specimens. There were more ger m cells in some patients with cloacal exstrophy, but this finding was not s pecific and is of unknown clinical significance. Conclusions. Despite the severity of the malformations in cloacal exstrophy , testicular histology is preserved. In highly selected genotypic males who have adequate phallic structures, congruent gender assignment is appropria te and early orchidopexy is recommended.