The effect of testosterone injection on the results of hypospadias surgery

Abstract

Surgical repair of hypospadias is a challenging reconstructive surgery. The main goals of this surgery are better cosmetic and functional results. A number of complications, including urethral fistula, urethral stricture, urethral diverticula and wound dehiscence have been reported for various hypospadias repair techniques. Hormone therapy is often used for children with hypospadias disease with a small penis or with proximal hypospadias. This method improves penis size, glandular diameter and vascularization. penile shortening can delayed wound healing and anastomotic repair for urethral. Therefore, increasing the tissue of the penis can prevent this. Androgen stimulation is often used to increase penile size before hypospadias surgery. We believed that the temporary increase in penile length, and surrounding tissue vascularity caused by androgen administration, facilitates hypospadias repair and improves functional and aesthetic outcomes. However, according to the review of the literature, there is conflicting information in this field and this issue is still controversial. Therefore, in this study, we intend to investigate the effect of pre-operative testosterone in patients with hypospadias on postoperative results. Methods: This study was conducted on children with hypospadias referred to Tabriz Children's Hospital from the beginning of 2022 to the end of March 2022. The patients referred to the clinic were first fully examined and the size of their glans and penis were measured and recorded. Then patients were divided into two groups. In the first group of patients, two weeks before the surgery, they received intramuscular injection of 2 mg/kg testosterone as a single dose, and the second group was the control group and did not receive testosterone. In the operating room, before the surgery, the size of the glans and penis was again measured and recorded. In the post-operative follow-up, patients were evaluated for complications such as bleeding, hematoma, surgical site infection, and fistula occurrence. Also, using the HOSE questionnaire, the result of hypospadias surgery was determined and recorded in the visit. Results: The size of the glans increased significantly in the testosterone group (p=0.05). In the investigation of surgical hypospadias complications, two cases of bleeding were observed in the testosterone group, and 7 cases of fistula, 1 case of diverticulum, and 1 case of urinary retention were observed in the control group. After three months, no significant difference was observed between the two groups in the follow-up of the patients with HOSE evaluation after the operation of urine flow, erection, and fistula. The need for reoperation was higher in the control group.