Ahmet Murat ÇAKMAK, Onur TELLİ, Gülnur GÖLLÜ BAHADIR, Farid KHANMAMMADOV, Ergun ERGÜN

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

Background/aim: Nowadays surgical intervention is possible in smaller phalluses and younger children with hypospadias disease. Different hormone treatments with different doses, modalities, indications, and treatment times come along with some disputes. The aim of this study is to evaluate the management approaches in hypospadias surgery of surgeons in regards to hormone preparations. Materials and methods: Questionnaires were sent via e-mail to 110 actively working pediatric surgeons and urologists. The answers of 99 surgeons were evaluated (90%). Two surgeons declared that they did not perform hypospadias surgery. Results: When testosterone usage in penile surgery was questioned, 44.4% of participants (n = 44) answered positively. Small-short penis glans, narrow urethral plate, chordee, disorders of sexual development, buccal mucosa-graft operations, slight tissue, and defective ventral skin were the indications for usage. Forty of forty-four surgeons stated usage in proximal hypospadias, 18 of them in penile hypospadias, and 15 of them in distal hypospadias. The most common form was dihydrotestosterone (62%). According to the respondents, fistulas (83%), infections (78%), and wound dehiscence (77%) were reduced. Fifty-six percent of the surgeons stated that bleeding was increased and 39% stated easier dissection. Conclusion: As a result of this questionnaire we can understand that there is no standard usage of testosterone in Turkey. Optimal points of usage can be introduced by increasing prospective randomized trials and education programs can ensure similar effective usage.

PDF

___

1. Baskin LS, Ebbers MB. Hypospadias: anatomy, etiology, and technique. J Pediatr Surg 2006; 41: 463-472.
2. Kraft KH, Shukla AR, Canning DA. Hypospadias. Urol Clin North Am 2010; 37: 167-181.
3. Netto JM, Ferrarez CE, Schindler Leal AA, Tucci S Jr, Gomes CA, Barroso U Jr. Hormone therapy in hypospadias surgery: a systematic review. J Pediatr Urol 2013; 9: 971-979.
4. Springer A, Krois W, Horcher E. Trends in hypospadias surgery: results of a worldwide survey. Eur Urol 2011; 60: 1184- 1189.
5. Davits RJ, van den Aker ES, Scholtmeijer RJ, de Muinck KeizerSchrama SM, Nijman RJ. Effect of parenteral testosterone therapy on penile development in boys with hypospadias. Br J Urol 1993; 71: 593-595.
6. Gilliver SC, Wu F, Ashcroft GS. Regulatory roles of androgens in cutaneous wound healing. Thromb Haemost 2003; 90: 978- 985.
7. Gilliver SC, Ashworth JJ, Mills SJ, Hardman MJ, Ashcroft GS. Androgens modulate the inflammatory response during acute wound healing. J Cell Sci 2006; 119: 722-732.
8. Wright I, Cole E, Farrokhyar F, Pemberton J, Lorenzo AJ, Braga LH. Effect of preoperative hormonal stimulation on postoperative complication rates after proximal hypospadias repair: a systematic review. J Urol 2013; 190: 652-659.
9. Malik RD, Liu DB. Survey of pediatric urologists on the preoperative use of testosterone in the surgical correction of hypospadias. J Pediatr Urol 2014; 10: 840-843.
10. Sakakibara N, Nonomura K, Koyanagi T, Imanaka K. Use of testosterone ointment before hypospadias repair. Urol Int 1991; 47: 40-43.
11. Ishii T, Hayashi M, Suwanai A, Amano N, Hasegawa T. The effect of intramuscular testosterone enanthate treatment on stretched penile length in prepubertal boys with hypospadias. Urology 2010; 76: 97-100.
12. Luo CC, Lin JN, Chiu CH, Lo FS. Use of parenteral testosterone prior to hypospadias surgery. Pediatr Surg Int 2003; 19: 82-84.
13. Ratan SK, Aggarwal SK, Mishra TK, Saxena A, Yadav S, Pandey RM, Sharma A, Dhanwal D. Hormonal profile in children with isolated hypospadias associates better with comprehensive score of local anatomical factors as compared to meatal location or degree of chordee. Indian J Endocrinol Metab 2014; 18: 558-564.
14. Snodgrass WT, Villanueva C, Granberg C, Bush NC. Objective use of testosterone reveals androgen insensitivity in patients with proximal hypospadias. J Pediatr Urol 2014; 10: 118-122.
15. Tsur H, Shafir R, Shachar J, Eshkol A. Microphallic hypospadias: testosterone therapy prior to surgical repair. Br J Plast Surg 1983; 36: 398-400.
16. Koff SA, Jayanthi VR. Preoperative treatment with human chorionic gonadotropin in infancy decreases the severity of proximal hypospadias and chordee. J Urol 1999; 162: 1435- 1439.
17. Chalapathi G, Rao KLN, Chowdhary SK, Narasimhan KL, Samujh R, Mahajan JK. Testosterone therapy in microphallic hypospadias: topical or parenteral? J Pediatr Surg 2003; 38: 221-223.
18. Nerli RB, Koura A, Prabha V, Reddy M. Comparison of topical and parenteral testosterone in children with microphallic hypospadias. Pediatr Surg Int 2009; 25: 57-59.
19. Monfort G, Lucas C. Dehydrotestosterone penile stimulation in hypospadias surgery. Eur Urol 1982; 8: 201-203.
20. Gorduza DB, Gay CL, de Mattos E Silva E, Demède D, Hameury F, Berthiller J, Mure PY, Mouriquand PD. Does androgen stimulation prior to hypospadias surgery increase the rate of healing complications? A preliminary report. J Pediatr Urol 2011; 7: 158-161.
21. Kaya C, Bektic J, Radmayr C, Schwentner C, Bartsch G, Oswald J. The efficacy of dihydrotestosterone transdermal gel before primary hypospadias surgery: a prospective, controlled, randomized study. J Urol 2008; 179: 684.