Review articleHormone therapy in hypospadias surgery: A systematic review
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).
References (16)
- et al.
Does androgen stimulation prior to hypospadays surgery increase the rate of healing complications? A preliminary report
J Ped Urol
(2011) - et al.
The efficacy of dihydrotestosterone transdermal gel before primary hypospadays surgery: a prospective, controlled, randomized study
J Urol
(2008) - et al.
Structural study of prepuce in hypospadays – does topical treatment with testosterone produce alterations in prepuce vascularization?
J Urol
(2011) - et al.
Gonadotropin and testosterone response in prepubertal boys with hypospadias
J Urol
(1986) - et al.
The use of parenteral testosterone therapy in genital reconstructive surgery
J Urol
(1987) - et al.
Preoperative treatment with human chorionic gonadotropin in infancy decrease the severity of proximal hypospadays and chordee
J Urol
(1999) - et al.
Testosterone therapy in microphallic hypospadays: topical or parenteral?
J Pediatr Surg
(2003) - et al.
The effect of intramuscular testosterone enanthate treatment on stretched penile length in prepubertal boys with hypospadays
J Urol
(2010)
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