The role of preoperative intra muscular testosterone in improving functional and cosmetic outcomes following hypospadias repair: A prospective randomized study

Autor: Sibi Chakravarthi, Ramesh Babu
Rok vydání: 2018
Předmět:
Zdroj: Journal of Pediatric Urology. 14:29.e1-29.e6
ISSN: 1477-5131
Popis: Summary Background There are very few well-designed studies on the role of preoperative testosterone in hypospadias repair. The aims of the current study are to ascertain the efficacy of intramuscular testosterone in increasing the glans width, reducing the complications and improving the functional and cosmetic outcomes. Materials and methods Between January 2013 and December 2016, a total of 200 patients with distal hypospadias were recruited to this prospective randomized study. Only patients with distal hypospadias eligible for a tubularized incised plate (TIP) repair were included. Group 1 did not receive any intervention, and group 2 received three doses of intramuscular testosterone enanthate 2 mg/kg at the age of 9, 10, and 11 months. Glans width was measured in millimeters in all patients using calipers at the time of recruitment and at the time of surgery. Within group 2, those who failed to have more than a 2 mm increase in size were considered non-responders (group 2a), and the remaining were taken to be responders (group 2b). TIP repair was performed by the same surgeon, and patients were followed up, looking for urethrocutaneous fistula, glans dehiscence, meatal stenosis, etc. Cosmetic evaluation was performed using the Parental Penile Perception Score (PPPS). Results A total of eight patients dropped out in group 1 (n = 92), while six dropped out in group 2 (n = 94). In group 2, 17% patients did not respond to testosterone (group 2a; n = 16), whereas 83% showed significant increase in glans width (group 2b; n = 78). The table compares the functional and cosmetic outcomes between groups. Total complications were significantly less in group 2b (17.9%) than in group 2a (50%). The reoperation rate was significantly less in group 2b (11.5%) than in group 1 (23.1%). A significantly higher number of parents (p = 0.03) were satisfied with cosmesis of the glans/meatus in group 2b (71/78; 91%) compared with group 2a (11/16; 69%) or group 1 (72/92; 78%). The overall PPPS was significantly higher (p = 0.003) in group 2b (8.88 ± 2.20) than in group 1 (8.03 ± 1.55). Discussion Two systematic reviews on the role of preoperative testosterone failed to reach any conclusion. One described a glans width Table . Comparison of the functional and cosmetic outcomes among the groups. No TST group 1 (n = 92) TST group 2 (n = 94) Group 1 vs. 2a (p) Group 1 vs. 2b (p) Group 2a vs. 2b(p) TST-non responders group 2a (n = 16) 17% TST responder group 2b (n = 78) 83% Urethrocutaneous fistula 7 (7.6%) 2 (12.5%) 4 (5.1%) 0.61 0.75 0.26 Glans dehiscence 13 (14.1%) 4 (25%) 3 (3.9%) 0.26 0.02 0.03 Meatal stenosis 6 (6.5%) 2 (12.5%) 7 (8.9%) 0.32 0.57 0.64 Total complications 26 (28.3%) 8 (50%) 14 (18%) 0.08 0.15 0.01 Reoperations 22 (23.9%) 5 (31.3%) 9 (11.5%) 0.53 0.04 0.06 Mean PPPS (SD) 8.03 ± 1.55 8.06 ± 0.68 8.88 ± 2.20 0.95 0.003 0.1 Parents satisfied with cosmesis 72 (78%) 11 (69%) 71 (91%) 0.52 0.03 0.03
Databáze: OpenAIRE
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