Spinoit, Anne-Françoise

Van Praet, Charles

Charles Van Praet

Anne-Françoise Spinoit

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Journal of Pediatric Urology

Testosterone prior to hypospadias repair: No clear-cut benefit or reassurance regarding long-term safety

Ghent University Academic Bibliography

Journal of Pediatric Urology (2018) 14, 85e86Department of Urology, GhentUniversity Hospital, Ghent,BelgiumCorrespondence to:A.-F. Spinoitafspinoit@hotmail.com (A.-F. Spinoit)2 November 2017Accepted 4 November 2017Available online 27 November2017DOI of original article: httphttps://doi.org/10.1016/j.jpu1477-5131/ª 2017 Journal of PTestosterone prior to hypospadiasrepair: No clear-cut benefit orreassurance regarding long-term safetyCharles Van Praet, Anne-Franc¸oise SpinoitThe benefit of androgenic stimulation prior tohypospadias surgery has long been debated.Its goal is to increase penile length andcircumference, and widen the glans and ure-thral plate to make the surgery easier anddecrease adverse events. Short-term side ef-fects include transient growth of pubic hair,possible growth retardation, erections, andincreased bleeding during surgery. Long-termside effects of pre-pubertal androgenic stim-ulation are ill studied.Rynja et al. examined 58 adults (mean age19.8 years) who underwent hypospadias repairas a child, including 24 patients who receivedtestosterone pre-operatively [1]. They foundno difference in postoperative complicationrate, or in adult body or penile length orcosmesis with regard to testosterone use. Only50% of the 121 eligible patients responded tothe investigators’ invitation. Selection biasmay have influenced their results, and theyhave too few included patients to perform anaccurate multivariate analysis. With the pre-sented data from a retrospective analysis of 24patients, it cannot be concluded, in ouropinion, that pre-pubertal testosterone appli-cation has no long-term side effects. Statisticslose their power in such a small population,and no conclusion can safely be drawn fromthese series, especially when many surgical oranatomical parameters have not been takeninto account.In a rat model, pre-pubertal androgenicstimulation decreased genital size and germcell count in adulthood [2], something whichhas not been reproduced in men but warrantsfurther study. Also, the effect of testosteroneon the androgen receptor, which seems to beless expressed in hypospadias, requires furtherinvestigation [3]. As 78% of pediatric urologistsin the US apply androgenic stimulation pre-operatively, it is important to understand itspossible long-term side effects [4].The European Association of Urology guide-lines give a level 1B recommendation fors://doi.org/10.1016/j.jpurol.2017.09.020.rol.2017.11.006ediatric Urology Company. Published by Elsevier Ltd. Aandrogenic stimulation, despite ambiguous evi-dence [5]. Recently, two randomized controlledtrials (RCT) demonstrated that pre-operativetestosterone application decreased complica-tion rate [6,7]. However, testosterone use isassociated with tissue healing problems andanother RCT demonstrated more wound dehis-cence following testosteroneadministration [8].This could have resulted from increased tissuevascularization and edema. A French RCT isinvestigating the effect of topical estrogen oncomplication rates. The study is completed, andresults are awaited (NCT01370798).In our institution, androgen stimulation isexceptionally administered prior to hypospa-dias repair, as advantages have not beenshown. We agree, however, that it can beconsidered in selected children with a verysmall glans, in the hopes of increasing size tofacilitate surgery.Further research is needed to determinewhether pre-operative testosterone improvessurgical outcome. Furthermore, possible long-term side effects should be assessed in largeprospective cohorts. Parents should beinformed about the benefits and risks of pre-operative androgenic stimulation.References[1] Rynja S, de Jong T, Bosch R, de Kort L.Testosterone prior to hypospadias repair:postoperative complication rates and long-termcosmetic results, penile length and bodyheight. J Pediatr Urol 2018;14:31e31.[2] Lee H, Jin MH, Kang HJ, Hong CH, Bang WJ,Park KK, et al. Timing of prepubertal androgenadministration may have different effects onfuture fertility as well as penile size in normalmale rats. Urology 2010;75:979e84.[3] Spinoit AF, Buelens S, Van Praet C, VanLaecke E, Praet M, Hoebeke P. Influence ofdartos tissue and the androgen receptor incongenital penile malformations: opening newhorizons in research with clinical relevance.Eur Urol Suppl 2017;16:177e81.ll rights reserved.86 C. Van Praet, A.-F. Spinoit[4] Malik RD, Liu DB. Survey of pediatric urologists on the pre-operative use of testosterone in the surgical correction ofhypospadias. J Pediatr Urol 2014;10:840e3.[5] Tekgu¨l S, Dogan HS, Kocvara R, Nijman JM, Radmayr C,Stein R. European association of urology guidelines on paedi-atric urology. 2017.[6] Asgari SA, Safarinejad MR, Poorreza F, Asl AS, Ghanaie MM,Shahab E. The effect of parenteral testosterone administra-tion prior to hypospadias surgery: a prospective, randomizedand controlled study. J Pediatr Urol 2015;11:143.e1e6.[7] Babu R, Chakravarthi S. The role of preoperative intramuscular testosterone in improving functional and cosmeticoutcomes following hypospadias repair: a prospective ran-domized study. J Pediatr Urol 2018;14:29e29.[8] Menon P, Rao KLN, Handu A, Balan L, Kakkar N. Outcomeof urethroplasty after parenteral testosterone in childrenwith distal hypospadias. J Pediatr Urol 2017;13. 292.e1ee7.

Testosterone prior to hypospadias repair : no clear-cut benefit or reassurance regarding long-term safety

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Testosterone prior to hypospadias repair : no clear-cut benefit or reassurance regarding long-term safety

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