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It also examines the correlation between the external masculinisation score (EMS) and surgical approach for improved preoperative planning.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cohort of 18 male-reared DSD patients with MDRs was prospectively managed laparoscopically, out of 20 initially considered cases. Surgical approaches included either longitudinal splitting\/division or near-total excision. G\u2013V\n                      <jats:sub>D<\/jats:sub>\n                      \u2013M\n                      <jats:sub>DR<\/jats:sub>\n                      classification was introduced, which categorises MDRs based on three anatomical parameters: (A) gonadal status (G0\u2013G3), (B) relation to the vasa deferentia (V0\u2013V2), and (C) degree of M\u00fcllerian development (M1\u2013M5). In addition, the predictive value of the EMS in determining surgical feasibility was evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with higher EMS (\u2265\u20098.5) were more likely to require MDR division due to complex MDR\u2013vas deferens relations, while those with EMS\u2009\u2264\u20095.5 underwent excision. Bilateral MDR\u2013vas deferens relations favoured division (83.3%), whereas unilateral or absent MDR\u2013vas deferens relations were more common in the excision group (41.6%\u00a0and 50%, respectively). A significant correlation was found between EMS and surgical approach (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The G\u2013V\n                      <jats:sub>D<\/jats:sub>\n                      \u2013M\n                      <jats:sub>DR<\/jats:sub>\n                      classification, combined with EMS assessment, offers a structured and predictive framework for optimising MDR surgical management. The need to achieve single-stage, tension-free orchidopexy and the anatomical relationship between MDRs and the vas deferens govern the choice between excision and division.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00383-025-06079-7","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:35:21Z","timestamp":1753886121000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Excision versus division of M\u00fcllerian duct remnants in male disorders of sexual development and differentiation: a prospective study to generate anatomical assessment criteria"],"prefix":"10.1007","volume":"41","author":[{"given":"Mohamed Sayed","family":"Abd El-Monsif","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6507-1200","authenticated-orcid":false,"given":"Ahmed Mohamed Kadry","family":"Wishahy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4582-1035","authenticated-orcid":false,"given":"Noha","family":"Arafa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2112-4611","authenticated-orcid":false,"given":"Mohamed Magdy","family":"Elbarbary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamal","family":"Eltagy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8670-1830","authenticated-orcid":false,"given":"Mahmoud Marei","family":"Marei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"6079_CR1","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.jpurol.2016.08.015","volume":"12","author":"KP Wolffenbuttel","year":"2016","unstructured":"Wolffenbuttel KP, Hersmus R, Stoop H et al (2016) Gonadal dysgenesis in disorders of sex development: diagnosis and surgical management. 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