Biometry of the hypospadic penis after hormone therapy (testosterone and estrogen): A randomized, double-blind controlled trial.
BACKGROUND
The use of preoperative hormonal stimulation before hypospadias surgery aims to increase penile size and achieve better surgical results; however, the rules are not clear in the literature. We evaluated the effects of topical testosterone and estrogen in the hypospadic penis regarding biometric measures, side effects, and serum hormonal levels. To our knowledge, this is the first study using estradiol prior to hypospadias surgery.


METHODS
Sixty-nine children with hypospadias were randomly divided into three study groups: a control group (CG) of 17 children given placebo cream; a testosterone group (TG) of 28 children who used 1% testosterone propionate; and an estradiol group (EG) of 24 children using 0.01% estradiol. All subjects applied the topical ointment on the entire penis, twice daily for 30 days before surgical correction. Biometric evaluation of the penis included penile length and diameter, glans diameter, distance from the urethral meatus to the tip, and the width of the urethral plate. These measurements as well as serum hormone level, and side effects were evaluated prior to hormone use, and 30 and 90 days after.


RESULTS
After 30 days an increase in penile diameter and length and diameter of the glans were observed in TG (p < 0.05). The width of the urethral plate and distance from meatus to the tip increased in TG, although not significantly. The most frequent side effects were appearance of pubic hair and darkening of the genital skin, mainly in TG, but these were transient and disappeared after 90 days of treatment. No significant variations were seen in serum hormonal levels (Table).


CONCLUSIONS
As in previous studies, an increase in penile length and diameter, and glans diameter was observed with the use of testosterone. Proximal urethral plate width and distance from the meatus to the tip of the penis had a tendency to increase also in TG. Estradiol did not change biometric measure of the penis. Few side effects occurred after both hormones, and any that did improved after 90 days follow-up and did not change hormone serum levels.


CONCLUSIONS
Preoperative use of topical testosterone increases penile size, diameter of the penis and glans. The use of estradiol does not change penile biometry. Side effects occur mainly with the use of testosterone and are transient. No significant and persistent hormonal changes were observed.
Division of Pediatric Surgery, Department of Pediatrics, Federal University of Juiz de Fora (UFJF), MG, Brazil; Division of Pediatric Surgery, Department of Pediatrics, Hospital and Maternidade Therezinha de Jesus of School of Medical Sciences and Health of Juiz de Fora (HMTJ/SUPREMA), MG, Brazil.
Kelly Christina de Castro
KC
Paiva
Department of Morphology, Federal University of Juiz de Fora (UFJF), MG, Brazil. Electronic address: andre@cortesvillela.com.br.
André Netto
AN
Bastos
Division of Urology, Department of Surgery, Hospital and Maternidade Therezinha de Jesus of School of Medical Sciences and Health of Juiz de Fora (HMTJ/SUPREMA), MG, Brazil.
Laura Pimenta
LP
Miana
Division of Urology, Department of Surgery, Hospital and Maternidade Therezinha de Jesus of School of Medical Sciences and Health of Juiz de Fora (HMTJ/SUPREMA), MG, Brazil.
Eveline de Souza
Ede S
Barros
School of Medical Sciences and Health of Juiz de Fora (HMTJ/SUPREMA), MG, Brazil.
Plínio Santos
PS
Ramos
Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
Lara Meneguelli
LM
Miranda
Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
Natália Maia
NM
Faria
Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
André
A
Avarese de Figueiredo
Division of Urology, Department of Surgery, State University of Feira de Santana (UEFS), BA, Brazil.
José
J
de Bessa
Division of Urology, Department of Surgery, Hospital and Maternidade Therezinha de Jesus of School of Medical Sciences and Health of Juiz de Fora (HMTJ/SUPREMA), MG, Brazil; Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil. Electronic address: jose.murillo@ufjf.edu.br.
José Murillo B
JM
Netto
D001699:Biometry; D002675:Child, Preschool; D004311:Double-Blind Method; D004967:Estrogens / Q000627:therapeutic use*; D006801:Humans; D007021:Hypospadias / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D010413:Penis / Q000187:drug effects* / Q000254:growth & development*; D013739:Testosterone / Q000627:therapeutic use*
D004967:Estrogens; D013739:Testosterone
Biometry; Children; Estradiol; Hypospadias; Penis; Testosterone