title: Meta-analysis of Androgen Insensitivity in Preoperative Hormone Therapy in Hypospadias.
abstract: OBJECTIVE
  To define androgen insensitivity prevalence in hypospadias patients treated with preoperative hormone therapy.
  
  
  METHODS
  We searched databases that were published in English and Chinese up to September 10, 2014 for our studies. Eligibility criteria were pre-established. Title, abstract, and full-text screenings were conducted by 2 authors independently. Discrepancies were resolved by consensus. Quality assessment of included studies was completed. Meta-analysis was done when appropriate using R, version 3.1.1 for Windows. Heterogeneity among individual studies was tested using the Cochran chi-square Q test and quantified by calculating the I(2) index.
  
  
  RESULTS
  Thirteen of 1278 publications met inclusion criteria and were incorporated into this study. Of 306 patients with preoperative hormone therapy, 25 displayed androgen resistance. Meta-analysis demonstrated that the random-effects model generates a pooled estimate of 7.14% (95% confidence interval [CI], 3.16%-15.31%), whereas the fixed-effect model provides an estimate of 14.61% (95% CI, 10.00%-20.85%). Heterogeneity among included studies was found above medium (I(2) = 67.1% [95% CI, 41.2%-81.6%]; P = .0003]. After exclusion of the heterogeneity, both random-effects and fixed-effect models produce a consistent pooled estimate of 6.95% (95% CI, 0%-47.8%).
  
  
  CONCLUSIONS
  We have defined that the prevalence of androgen resistance in hypospadias is 7.14% (95% CI, 3.16%-15.31%). To distinguish isolated hypospadias from patients with androgen insensitivity syndrome, we recommend that androgen-resistant patients should be specifically targeted by molecularly focused diagnosis. Management strategies should include identification of mutations in the androgen receptor gene, timely surgery to repair hypospadias, and long-term follow-up of sexual function and fertility later in life.
authors: Department (I) of Paediatric Urology, Shenzhen Children's Hospital, Shenzhen, China.
authors: Weiguang
authors: W
authors: Zhao
authors: Department (I) of Paediatric Urology, Shenzhen Children's Hospital, Shenzhen, China.
authors: Jianchun
authors: J
authors: Yin
authors: Department (I) of Paediatric Urology, Shenzhen Children's Hospital, Shenzhen, China.
authors: Zhilin
authors: Z
authors: Yang
authors: Department (I) of Paediatric Urology, Shenzhen Children's Hospital, Shenzhen, China.
authors: Jinjin
authors: J
authors: Xie
authors: Department (I) of Paediatric Urology, Shenzhen Children's Hospital, Shenzhen, China.
authors: Yingtian
authors: Y
authors: Zhang
authors: Department (I) of Paediatric Urology, Shenzhen Children's Hospital, Shenzhen, China.
authors: Wanhua
authors: W
authors: Xu
authors: School of Biotechnology, Southern Medical University, Guangzhou, China; Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Electronic address: jli.smu@gmail.com.
authors: Ji-Liang
authors: JL
authors: Li
mesh_terms: D013734:Androgen-Insensitivity Syndrome / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006801:Humans; D007021:Hypospadias / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D007223:Infant; D008297:Male; D011300:Preoperative Care; D015995:Prevalence; D013739:Testosterone / Q000627:therapeutic use*
chemical_list: D006063:Chorionic Gonadotropin; D013739:Testosterone