Review article
Hormone therapy in hypospadias surgery: A systematic review

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Abstract

Surgical correction of hypospadias is proposed to improve the aesthetic and functional quality of the penis. Hormone therapy preceding surgical correction is indicated to obtain better surgical conditions. However, there is divergence in the literature regarding the hormone therapy of choice, time of its use before surgery, appropriate dose, and route of application.

To try to elucidate this matter, an electronic survey of the databases PubMed and Cochrane Central Library was conducted, limited to articles in English published since 1980. Search strategy identified 14 clinical trials that matched the inclusion criteria. Analysis was made in terms of study design, classification of hypospadias, association with chordee and cryptorchidism, type of hormone, route of application, dose and duration of treatment, penile length before and after hormone therapy, glans circumference before and after hormone therapy, adverse effects, and surgical complications.

From the trials evaluated it was not possible to determine the ideal neoadjuvant treatment. A preference for use of testosterone was observed. Intramuscular administration seems to have fewer adverse effects than topical treatment. Side effects were seldom described, and treated patients were not followed on a long-term basis. The scarcity of randomized and controlled clinical trials regarding the topic impairs the establishment of a protocol.

In conclusion, although preoperative hormone therapy is currently used before hypospadias surgery, its real benefit in terms of improvement of the penis and surgical results has not been defined.

Introduction

Hormone therapy prior to hypospadias surgery is controversial. It has been proposed that better surgical conditions are obtained when hormones are used prior to hypospadias surgery, favoring better local skin conditions, reducing surgical complications, and temporarily increasing penile length and glans circumference [1]. Different hormones have been proposed: human chorionic gonadotropin (HCG), dihydrotestosterone (DHT) or testosterone. However, there are divergences about the hormone therapy of choice, time of use, appropriate dose, and means of application (topical or parenteral).

On this basis, the present systematic review compares the results of different types of hormone therapy for hypospadias correction.

Section snippets

Materials and methods

An electronic survey was conducted of the PubMed and Cochrane Library databases from August to October 2011, with cross-reference of the terms hypospadias, testosterone, dihydrotestosterone, DHT, human chorionic gonadotropin, HCG, and hormone therapy. Search was limited to articles written in English and published in the last 30 years (since 1980). This first search led us to 466 articles.

Inclusion criteria were clinical trials on humans and use of hormone therapy before surgery for hypospadias

Results

The number of patients in the selected studies ranged from 7 to 98 and children's age from 0 to 16 years.

Discussion

Hormone therapy preceding hypospadias correction is a controversial subject, and although widely used there is still scarce data in the literature to support it. Testosterone use was first reported in 1971 [16] and it was the hormone of choice for many investigators. This systematic review compared 14 clinical trials for a total sample of 473 patients, 300 of whom were treated with testosterone, 120 DHT, 140 HCG, and 98 LHRH (some patients received combination of two drugs).

Although all studies

Conclusion

Hormone therapy preceding hypospadias correction has been infrequently reported although it is commonly used all over the world. The scarcity of randomized and controlled clinical trials on this topic prevents the establishment of a standard protocol. The non-randomized studies that describe this therapy involve limited numbers of patients and do not evaluate important variables in treatment regimens, adverse effects and surgical outcome.

Despite the current use of hormone therapy before

Conflict of interest

The corresponding author received support of the State of Minas Gerais Research Foundation (Fundação de Amparo a Pesquisa do Estado de Minas Gerais - FAPEMIG) to present this paper at the AUA Annual Meeting in Atlanta, May 2012.

Funding

None declared.

Acknowledgement

We would like to thank the support of FAPEMIG - Fundação de Amparo a Pesquisa do Estado de Minas Gerais (Reaserch Foundation of the State of Minas Gerais).

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