Robert A Swendiman1, Maria G Vogiatzi2, Craig A Alter3, Michael L Nance4. 1. Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA. Electronic address: robert.swendiman@uphs.upenn.edu. 2. Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: vogiatzim@email.chop.edu. 3. Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: alterc@email.chop.edu. 4. Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: nance@email.chop.edu.
Abstract
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.
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.
Authors: Jadranka Popovic; Mitchell E Geffner; Alan D Rogol; Lawrence A Silverman; Paul B Kaplowitz; Nelly Mauras; Philip Zeitler; Erica A Eugster; Karen O Klein Journal: Front Pediatr Date: 2022-10-04 Impact factor: 3.569