1606 THE HISTOLOGICAL REACTION OF FORESKIN AFTER TESTOSTERONE TREATMENT PRIOR TO HYPOSPADIAS SURGERY

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia II1 Apr 20121606 THE HISTOLOGICAL REACTION OF FORESKIN AFTER TESTOSTERONE TREATMENT PRIOR TO HYPOSPADIAS SURGERY Hidenori Nishio, Kentaro Mizuno, Yoshinobu Moritoki, Makoto Imura, Hideyuki Kamisawa, Atsushi Okada, Yukihiro Umemoto, Yoshiyuki Kojima, Keiichi Tozawa, Yutaro Hayashi, and Kenjiro Kohri Hidenori NishioHidenori Nishio Nagoya, Japan More articles by this author , Kentaro MizunoKentaro Mizuno Nagoya, Japan More articles by this author , Yoshinobu MoritokiYoshinobu Moritoki Nagoya, Japan More articles by this author , Makoto ImuraMakoto Imura Nagoya, Japan More articles by this author , Hideyuki KamisawaHideyuki Kamisawa Nagoya, Japan More articles by this author , Atsushi OkadaAtsushi Okada Nagoya, Japan More articles by this author , Yukihiro UmemotoYukihiro Umemoto Nagoya, Japan More articles by this author , Yoshiyuki KojimaYoshiyuki Kojima Nagoya, Japan More articles by this author , Keiichi TozawaKeiichi Tozawa Nagoya, Japan More articles by this author , Yutaro HayashiYutaro Hayashi Nagoya, Japan More articles by this author , and Kenjiro KohriKenjiro Kohri Nagoya, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1401AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Androgens positively affect penile growth in children. Androgen stimulation is often used prior to hypospadias surgery in an attempt to increase penis size when the penis is too small to repair. Although recent publications have shown negative effects of androgens on normal skin healing, its influence on the foreskin of hypospadias is not clear. We histologically evaluated the foreskin to elucidate the effects of androgen stimulation before hypospadias surgery. METHODS Of 134 boys who underwent the first step of hypospadias repair at our institute from January 2005 to August 2011, we performed preoperative androgen treatment in 10 boys with small penises. These cases received as many as 3 intramuscular injections of testosterone enanthate (25 mg) every 4 weeks. We obtained excess foreskin that had been excised during surgery and compared histological findings in hormonal treatment and non-treatment cases. We also performed immunohistochemistry using anti-VEGF and collagen type I and type III antibodies. RESULTS The mean age at surgery was 31.3 and 20.8 months in treatment and non-treatment groups, respectively. Testosterone enanthate treatment significantly increased penile length from 20.6 ± 5.8 mm to 30.1 ± 4.3 mm (p<0.0001) and the glans width from 10.3 ± 2.1 mm to 12.9 ± 2.4 mm (p=0.008). We histologically evaluated the foreskin of 117 out of 134 cases. In the treatment group (n=9), we observed edema, fibrosis, and inflammation in 6 (66.7%), 6 (66.7%), and 7 (77.8%) cases, respectively. In the non-treatment group (n=108), we observed edema, fibrosis, and inflammation in 19 (17.9%), 17 (16.0%), and 46 (43.4%) cases, respectively. These histological findings were significantly increased in the foreskin after testosterone treatment (p < 0.005, p < 0.005, p = 0.078, respectively). VEGF expression was higher in the foreskins of the treatment group than in the non-treatment group. CONCLUSIONS Testosterone administration prior to hypospadias surgery in small penile cases is useful because it significantly enlarges penile size. In the present study, significant histological changes such as edema and fibrosis were found in the treatment group foreskins compared to the non-treatment group, suggesting that the effects of testosterone on the foreskin stroma via the androgen receptor facilitates these changes. High VEGF protein expression in the treatment group suggests that topical testosterone led to angiogenesis via VEGF expression and subsequently induced distinctive histological reactions of the foreskin. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e650 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hidenori Nishio Nagoya, Japan More articles by this author Kentaro Mizuno Nagoya, Japan More articles by this author Yoshinobu Moritoki Nagoya, Japan More articles by this author Makoto Imura Nagoya, Japan More articles by this author Hideyuki Kamisawa Nagoya, Japan More articles by this author Atsushi Okada Nagoya, Japan More articles by this author Yukihiro Umemoto Nagoya, Japan More articles by this author Yoshiyuki Kojima Nagoya, Japan More articles by this author Keiichi Tozawa Nagoya, Japan More articles by this author Yutaro Hayashi Nagoya, Japan More articles by this author Kenjiro Kohri Nagoya, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...