Effect of Preoperative Hormonal Therapy on Hypospadias Repair - Abstract
Background: Hypospadias repair is frequently associated with numerous complications including bleeding and hematoma, edema, wound infection, wound
dehiscence, skin and flap necrosis, meatal stenosis, urethral strictures, urethral diverticula, urethrocutaneous fistulization and scar formation.
Hormone therapy preceding surgical correction is indicated to obtain better intra-operative conditions. The logic behind the use of preoperative androgen is that it will lead to an increased vascularization of the prepuce, which will allow for a decrease fibrous tissue formation and inflammation. In addition to this, the increase blood flow postoperatively can potentially decrease complications and improve cicatrization through improved cutaneous nutrition and oxygenation.
Aim of the work: To find out the effect of Human Chorionic Gonadotrophin and androgen if given pre-operatively on the outcome of hypospadias surgery.
Patient and methods: Thirty male patients with different types of hypospadias were enrolled in this study, as Group A receiving preoperative hormonal therapy and other 30 patients with the same inclusion criteria included as control group B to be operated upon without receiving preoperative hormones. Patients in group A have received local dihydrotestosterone cream for 3 months.
Results: There were statistical significance differences between the two groups regarding the length, Group A (4.5 ± 0.33), Group B (3.17 ± 0.33) and in glandular width before and after hormonal therapy in Group A (1.7 ± 0.37), and Group B (1.5 ± 0.4). The mean duration of operation in Group A was 93.27 minutes. While in Group B it was 86.27 minutes. Postoperative complications were more in Group B with significant difference in meatal stenosis which was more in Group B.
Conclusion: Hormonal therapy before hypospadias operation is used by many pediatric surgeons and proved to achieve many beneficial results before the repair of hypospadias. These results include larger phallic size, more vascularity, better healing and less complications. Nevertheless, larger studies need to be done with more patients to develop more accurate treatment guidelines.