Hormone therapy in hypospadias surgery: a survey on the current practice in Turkey

Bahadir, Gülnur Göllü; Ergün, Ergun; Telli, Onur; Khanmammadov, Farid; Çakmak, Ahmet

doi:10.3906/sag-1507-72

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…When surveyed, surgeons have suggested PHT increases bleeding, 3 but this is inconsistent with several operative papers 32,33 . One study ceased PHT 5‐weeks pre‐operatively to reduce any theoretical risk of intra‐operative bleeding.…”

Section: Impact On Hypospadias Surgery Outcomesmentioning

confidence: 99%

“…24 Trials have shown reduced rates of urethrocutaneous fistula, 16 frequently reaching statistical significance 23,24 with results confirmed through meta-analysis of a subset of three pooled randomised controlled trials. 9 When surveyed, surgeons have suggested PHT increases bleeding, 3 but this is inconsistent with several operative papers. 32,33 One study ceased PHT 5-weeks pre-operatively to reduce any theoretical risk of intra-operative bleeding.…”

Section: Impact On Hypospadias Surgery Outcomesmentioning

confidence: 99%

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Defining the role of pre‐operative hormonal therapy in hypospadias

Taghavi

O'Hagan

Hewitt

et al. 2022

J Paediatrics Child Health

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In hypospadias surgery, pre-operative hormonal therapy (PHT) is primarily used to increase penile dimensions and the vascularity of tissues available for reconstruction, but its use is non-uniform in clinical practice, with no consensus on application or utility. This review aims to summarise: (i) the penile tissue response to hormone therapy, (ii) its impact on hypospadias surgery outcomes, and (iii) the endocrinological considerations and sequelae. PHT is more often indicated for complex cases such as proximal hypospadias, hypospadias with microphallus and hypospadias reoperations. While PHT has clear effects on penile morphometry, and more recent controlled trials suggest improved surgical outcomes, the lack of consistent outcome definitions and generally inadequate follow-up periods continue to consign many of the potential long-term effects of PHT to the unknown. There is currently insufficient robust evidence to allow a clinical guideline to be constructed. The need for a well-powered multi-centre prospective randomised trial to address this question is evident but awaits a unified consensus on issues surrounding the understanding of aetiology, classification of hypospadias morphology, definition of important prognostic variables and uniform application of outcome measures. The effects of PHT may be utilised to improve outcomes in cases of proximal and severe hypospadias, which under the current paradigm represent a significant surgical challenge.

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Section: Impact On Hypospadias Surgery Outcomesmentioning

confidence: 99%

Section: Impact On Hypospadias Surgery Outcomesmentioning

confidence: 99%

Defining the role of pre‐operative hormonal therapy in hypospadias

Taghavi

O'Hagan

Hewitt

et al. 2022

J Paediatrics Child Health

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“…Hypospadias is a congenital penile deformity characterized by an aberrant proximal placement of the urethral meatus on the ventral penis and a lack of ventral foreskin and a curve of the ventral penis [1,2]. Bleeding and hemorrhage, edema, wound infection, wound dehiscence, skin and flap necrosis, penile torsion, penile erection, meatal stenosis, urethral strictures, urethral diverticula, urethral-cutaneous fistulation, and scar formation are all expected consequences of hypospadias restoration [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…Preoperative hormone treatment with human chorionic gonadotropin (HCG), dihydrotestosterone (DHT), or testosterone (T) was recommended to improve the surgical result of people having hypospadias correction [2,3]. Hormone treatment is recommended before surgery to improve intraoperative circumstances [1,4]. The rationale for using preoperative androgen is that it will promote vascularization of the prepuce, reducing fibrous tissue growth and inflammation.…”

Section: Introductionmentioning

confidence: 99%

“…By increasing cutaneous feeding and oxygenation, increased blood flow following surgery can decrease complications and avoid scar formation [2]. Testosterone was successfully used to increase the breadth of the glans by 4.5 mm in proximal hypospadias newborns with small glans, reducing the incidence of issues associated with small glans size [1,2,5].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of preoperative testosterone therapy in hypospadias: a systematic review and meta-analysis

Sembiring

Sigumonrong

2021

Ann Pediatr Surg

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Background Bleeding, hematoma, edema, wound infection, and scar formation are the common problems linked with hypospadias reconstruction. Hormone treatment is recommended before surgical treatment to improve intraoperative circumstances. However, no meta-analysis has explored the effectiveness and side effects of testosterone treatment before surgery in hypospadias. Main body of the abstract The purpose of this paperwork is to evaluate the impact of preoperative testosterone treatment in hypospadias based on clinical data from published trials. This study searched MEDLINE, Science Direct, and the Cochrane Library without regard to year. However, only English journals were included, with a manual search using the Preferred Reporting Items for Systematic Reviews and Meta-analysis of Observational Studies in Epidemiology Guidelines supplementing the search. In this meta-analysis, five papers were considered. Two of these investigations were multicenter randomized clinical trials. Two of the studies were prospective, with a median follow-up of varying lengths. A retrospective investigation was conducted. There were 585 patients in all that took part in this trial. After surgery, the complication rate was measured in both the intervention and control groups, including meatal stenosis, fistula, glans dehiscence, scarring, reoperation rate, urethral diverticulum, fine pubic hair, and sexual precocity. The only significant difference between the intervention and control groups was that the intervention group had a decreased frequency of glans dehiscence following surgery (OR 0.40 with the 95% CI of 0.17 until 0.97). Conclusions This study discovered that a patient who got testosterone before surgery had a considerably decreased complication risk for glandular dehiscence. Reoperation rate, urethral-cutaneous fistula, meatal stenosis, and penile scarring in children with hypospadias, on the other hand, revealed no significant difference in the testosterone-treated group against the control group.

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