Abstract
BackgroundAlthough the outcome of hypospadias repair has much improved, repair of a small-sized phallus is still challenging. Whether preoperative hormonal therapy is beneficial remains controversial.In this report, we prospectively conducted a clinical trial comparing two groups of patients regarding the effect of preoperative topical testosterone application on the outcome of primary hypospadias repair.ResultsThe study included 40 cases of primary hypospadias with a small glans. Their age ranged from 6 months to 3 years. Patients were divided into two equal groups. Group A were treated by local application of testosterone topical gel 1% for 30–40 days and stopped one month before operation, while cases in group B did not receive preoperative hormonal treatment. Genital skin biopsies were taken for histopathological examination. For group A, penile measurements were documented before and after hormonal therapy.There was a significant increase in all penile parameters after hormonal stimulation in group A. Interestingly, the ventral penile length proximal to the meatus showed more growth in response to hormonal stimulation compared to ventral penile length distal to meatus.We did not find significant difference between both groups regarding the rate of postoperative complications. Also, the cosmesis and parent satisfaction were ‘more or less’ similar. On the histopathological level, we could not detect a difference between both groups regarding micro-vessel density using CD31, which is a vascular marker indicating neovascularization supposed to play a fundamental role in the healing process.ConclusionThe use of preoperative topical testosterone significantly increases the size of the hypospadiac phallus. However, this increase in size appears to be disproportionate on the ventral penile surface and has not been reflected on improving the surgical outcome.Level of evidenceThis is a case control study (level III evidence).
Highlights
The outcome of hypospadias repair has much improved, repair of a small-sized phallus is still challenging
The use of preoperative topical testosterone significantly increases the size of the hypospadiac phallus
This increase in size appears to be disproportionate on the ventral penile surface and has not been reflected on improving the surgical outcome
Summary
The outcome of hypospadias repair has much improved, repair of a small-sized phallus is still challenging. We prospectively conducted a clinical trial comparing two groups of patients regarding the effect of preoperative topical testosterone application on the outcome of primary hypospadias repair. Hypospadias is one of the most common congenital anomalies, with an incidence of about one in every 250 newborns [1]. Hypospadias represents a wide spectrum of abnormalities involving the inferior surface of the penis and having in common a urethral opening that lies on the inferior surface of the penis [2]. Repair of a small hypospadiac phallus can be technically challenging. The lack of scientific evidence results in the use of empirical judgment when the surgeon is confronted with a small hypospadiac phallus [10]
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