title: Outcome of urethroplasty after parenteral testosterone in children with distal hypospadias.
abstract: BACKGROUND
  Pre-operative testosterone use in hypospadias surgery is known to increase penile dimensions and vascularity, which should facilitate tension-less formation of the urethral tube and tissue healing. However, androgens can have a negative effect on wound healing. There are very few randomized studies on postoperative results after androgen use, and this study attempted to understand the utility of pre-operative testosterone in distal hypospadias.
  
  
  OBJECTIVE
  To study the effect of parenteral testosterone in children undergoing single stage urethroplasty for distal hypospadias, especially the occurrence of urethrocutaneous fistula and wound dehiscence.
  
  
  METHODS
  Patients were prospectively enrolled and randomized into two groups: Group 1 (control group) and Group 2 (receiving three injections of pre-operative intramuscular testosterone enanthate (2 mg/kg) at 1 monthly intervals; they were further subdivided into those operated 1 month (Group 2A) or 3 months (Group 2B) later. Patients with micropenis, previous testosterone use or any surgical intervention were excluded. Preputial skin was studied with hematoxylin and eosin (H&E) staining and CD31 immunohistochemistry. Patients were followed up for at least 18 months.
  
  
  RESULTS
  Ninety four patients underwent urethroplasty over a 3.5-year period. Penile dimensions increased significantly after testosterone use (Summary table). On H&E staining, proliferating blood vessels and increased lymphocytic infiltrates were significantly increased in Group 2B. Group 2 patients tended to have more postoperative edema and inflammation. Although urethrocutaneous fistula rates were similar in Group 1 (n = 7) and Group 2 (n = 5) (P = 0.438), wound dehiscence occurred only in Group 2 (P = 0.01).
  
  
  CONCLUSIONS
  The total number of patients in this study was small and this was a drawback. Although, several factors played a role in wound healing, the overall higher complication rate, especially wound dehiscence in Group 2, pointed to a higher incidence of inflammatory reaction and healing complication rates with testosterone use.
  
  
  CONCLUSIONS
  Testosterone should be used judiciously in distal hypospadias. While tissue availability significantly increased, there was an increase in inflammatory reaction and edema, which increased the risk of wound dehiscence in cases of precocious surgery.
authors.affiliation: Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: menonprema@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Menon
authors.affiliation: Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: K L N
authors.initials: KLN
authors.lastname: Rao
authors.affiliation: Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: A
authors.initials: A
authors.lastname: Handu
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: L
authors.initials: L
authors.lastname: Balan
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: N
authors.initials: N
authors.lastname: Kakkar
mesh_terms: D000728:Androgens / Q000008:administration & dosage*; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000453:epidemiology*; D004334:Drug Administration Schedule; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D013529:Surgical Wound Dehiscence / Q000453:epidemiology*; D013739:Testosterone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014521:Urethra / Q000601:surgery; D014548:Urinary Fistula / Q000453:epidemiology*
chemical_list: D000728:Androgens; D013739:Testosterone; C004648:testosterone enanthate
keywords: Distal; Glans dehiscence; Hypospadias; Parenteral; Testosterone; Urethrocutaneous fistula