Does androgen stimulation prior to hypospadias surgery increase the rate of healing complications? - A preliminary report.
OBJECTIVE
Androgens have a positive effect on penile growth in children, but they may also have a repressive effect on the healing process. The aim of this prospective study was to compare the outcomes of onlay urethroplasty with and without preoperative androgen stimulation in patients with severe hypospadias.


METHODS
Of 300 severe hypospadias cases treated at a single institution, 126 operated on by the same surgeon had complete follow-up data, and 30 of these received preoperative androgen treatment (human chorionic gonadotrophin and/or systemic testosterone) 1-24 months before surgery.


RESULTS
Thirty-five patients presented with a complication (27.7%) of whom 26 (20.6%) had a fistula or dehiscence. Among patients on androgen stimulation there was a 30% healing complication rate (9/30) whereas for those without this was 17.7% (17/96). When androgenic treatment was given > 3 months prior to surgery the healing complication rate was 21.7% (5/23), and when < 3 months prior to surgery the rate reached 57% (4/7). Mean follow up was 41 months (10-97).


CONCLUSIONS
Although the numbers were too small in this series to reach statistical significance, the tissular interactions of androgens in the healing process reported by dermatologists should alert the hypospadiologists and lead to a further prospective study to define the optimal protocol for stimulation of the penis in specific cases without affecting outcome.
Gorduza
Daniela B
DB
Department of Pediatric Urology, Hôpital Mère-Enfants, Bron Cedex, France.
Gay
Claire-Lise
CL
de Mattos E Silva
Elisângela
E
Demède
Delphine
D
Hameury
Frédéric
F
Berthiller
Julien
J
Mure
Pierre-Yves
PY
Mouriquand
Pierre D
PD
D000728:Androgens / Q000627:therapeutic use*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D012189:Retrospective Studies; D013739:Testosterone / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects*
D000728:Androgens; D018997:Chorionic Gonadotropin, beta Subunit, Human; D013739:Testosterone