Testosterone in surgical repair of proximal hypospadias comparative study

Abstract

Hypospadias is one of the most common congenital anomalies, occurring in approximately 1 in 250 newborns.Hypospadias is 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. The penis grows less than 0.8 cm in the first 3 years of life: the phallus that is small at 3 months of age will still be small at 3 years of age. Repair of the microphallichypospadiac penis can be technically challenging. The use of preoperative androgen therapy to enhance penile size before genital reconstruction has been proposed to improve the cosmetic and surgical results of these demanding operations. Whether preoperative endocrine therapy is really beneficial is controversial. Although some studies have favored hormonal administration before hypospadias repair, others concluded that preoperative testosterone actually had a higher risk of complications. Randomized trials have found no significant difference in outcome with topical or intramuscular routes of administration. One study concluded that there was adisproportional growth response to androgens between the proximal and distal penile shaft and the current study found almost same results,which means significant distal migration of the meatus. Till now no consensus about the protocol to use hormonal stimulation regarding hormone therapy of choice, appropriate dose, frequency, concentration, route of application. In this study, we found significant increase in all measurements of the phallus by using topical testosterone 1% once daily for 30-40 days,and concluded no significant difference in the results between the 2 group apart from edema which is more in treated group and skin shape which is better in the treated group. Moreover we didn`t faced with significant healing complications or local complications like skin pigmentation or irritation following hormonal stimulation. One randomized study evaluated thehistological effects of topical testosterone on vascularization,reaching the conclusion that this use promotes an increasein both the number and volume density of blood vessels after using 1 % testosterone topically before hypospadias surgery. As regards the assessment of the microvessel densityusing CD31 immunostaining ,we could not figure out significant difference between testosterone treated hypospadiac group and those untreated hyopspadiac