Pre-operative hormone stimulation in hypospadias repair: A facilitator or a confounder. Issue 3 (June 2020)

• Record Type: Journal Article
• Authors: Mohammadipour, Ahmad; Hiradfar, Mehran; Sharifabad, Parisa Saeedi; Shojaeian, Reza
• Is Part Of: Journal of pediatric urology. Volume 16:Issue 3(2020)
• Page Start: 318.e1
• Page End: 318.e7
• Publication Date: 2020-06
• Subjects: Hypospadias -- Androgen -- Testosterone; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2020.04.012
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Introduction: Preoperative hormone stimulation (PHS) is popular in hypospadias reconstructive surgery. While still controversial, it is performed to have a more developed gross anatomy of the glans and penis for improvement of the surgical condition and outcome. Objective: In this study we assessed morphometric and histologic effects of pre-operative testosterone therapy on the penis and prepuce in patients with hypospadias. Study design: 18 patients with hypospadias who received 3 monthly doses of 25 mg testosterone injections were compared with 23 patients with hypospadias who were managed without pre-operative androgen therapy. Penile morphometry and hormone side effects were assessed in monthly pre-operative visits. Intra operative observations and preputial histopathology were also compared between the groups. Results: Glans diameter enlarged significantly after the first dose of testosterone. (P < 0.001) while morphologic changes were not significant by further injections. 72.2% showed one or more hormone related side effects that were mostly mild. Severe side effects such as thick pubic hair growth, frequent erections or considerable penis hyper-sensation were observed in 27.8%. Glans to corpus ratio was 0.2 ± 0.75 in PHS group compare to 0.3 ± 0.17 in control group. (P < 0.001). Hemorrhage needing tourniquet placement was reported in 44.4% of the PHS patients compared to 26.1% among the control group. Histopathologic studies revealed increased vascularity and less inflammation of the prepuce in PHS group compared to controls. Discussion: The glans and penis enlargement wasn't significant in 22.2% of patients who underwent PHS. We identified the first dose of testosterone as the most effective one. This finding supports the idea of close clinical monitoring to stop PHS when a significant response is observed and the expected goals are reached. Androgen side effects were not uncommon among our patients although they were mainly mild. Intraoperative assessments showed a decreased glans wing thickness to corporal body ratio in PHS group compared to controls. This finding caused more complex glanuloplasty while wrapping the glans wings over neo urethra and enlarged corporal bodies. Conclusion: We suggest limiting PHS to carefully selected cases considering the observed anatomical and histological changes and the side effects. Monthly monitoring during PHS is recommended to stop androgen therapy as soon as the minimum defined targets are reached. This may decrease the rate of androgen side effects while providing better surgical conditions. Summary Table Penile morphometry in two groups of hypospadias cases with and without PHS. Penile morphometry During fallow up Glans diameter P Value Penile length P Value PHS group Control PHS group Control Initial visit 12.8 ± 1.04 18.3 ± 1.71 0.011 28.9 ± 4.19 36.0 ± 5.96 0.025 First month visit 15.7 ± 1.27 18.4 ± 1.64 0.351 30.1 ± 4.28 37.1 ± 5.27 0.109 Second month visit 16.3 ± 1.07 18.9 ± 1.45 0.437 31.2 ± 3.94 37.3 ± 5.27 0.069 Third month visit 16.8 ± 1.27 19.1 ± 1.57 0.174 31.6 ± 3.77 37.7 ± 5.25 0.073