Exploring the Benefits of Preoperative Androgen Stimulation in Hypospadias Surgery: A Histological Analysis of Neovascularization

Abstract

Abstract Introduction: The administration of androgens prior to hypospadias surgery is recommended to enhance penile growth, improve neovascularization, and facilitate surgical correction, leading to improved cosmetic results. This study aimed to investigate the histological differences in neovascularization between hypospadiac patients who received preoperative testosterone and those who did not. Materials and Methods: A total of 33 boys aged 1–5½ years with anterior, medial, posterior penile or scrotal hypospadias were included in the study. Eighteen patients (Group A) received testosterone at a dosage of 25 mg intramuscularly every 4 weeks for 2–4 doses, with a maximum dose of 100 mg, as directed by an endocrinologist. Fifteen patients (control Group B) underwent hypospadias repair without androgen stimulation. During surgery, tissue samples were obtained from the prepuce and urethral plate (if possible). The samples were stained using immunohistochemical methods with anti-CD31 and anti-VEGF (Vascular Endothelial Growth Factor) antibodies. The number of microvessels with CD31 index and the intensity of VEGF expression in vessels, positive cells, and stroma were evaluated. Results: The microvessel count with CD31 index and the expression of VEGF in vessels and positive cells were significantly higher in hypospadiac patients who received preoperative testosterone compared to the control group (P < 0.001). Conclusion: These findings suggest that preoperative testosterone administration may enhance neovascularization in hypospadiac patients and should be considered in preoperative treatments, especially when using prepucial flaps. Further studies are needed to elucidate the role of vascularity in surgical repair and to validate these findings.