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JU INSIGHT: Quantifying Glans Width Changes in Response to Preoperative Androgen Stimulation in Patients Undergoing Hypospadias Repair

By: Sameer Mittal, MD; Sahar Eftekharzadeh, MD; Sarah S. Christianson, DO; Nathan Hyacinthe, BS; Connie Tan, BA; Dana A. Weiss, MD; Jason Van Batavia, MD; Steve A. Zderic, MD; Aseem R. Shukla, MD; Thomas F. Kolon, MD; Arun K. Srinivasan, MD; Douglas A. Canning, MD; Mark R. Zaontz, MD; Christopher J. Long, MD | Posted on: 01 Jun 2022

Mittal S, Eftekharzadeh S, Christianson SS et al: Quantifying glans width changes in response to preoperative androgen stimulation in patients undergoing hypospadias repair. J Urol 2022: 207: 1314.

Figure. Study summary. IM, intramuscular.


Study Need and Importance

Administration of testosterone (T) to prepubertal boys prior to hypospadias surgery is performed to increase the glans width (GW) in hopes of decreasing complication development. Although it is known that T increases the penile size, the route of administration, the expected growth response and the impact on surgical outcomes remain unknown.

What We Found

We analyzed penile biometrics of 579 patients with complete data from our standardized hypospadias template. Patients receiving intramuscular T experienced a significant and dose-dependent response. The median increase in GW was 4 mm for 2 doses compared to 2 mm for a single dose. The GW in patients given vs those not given T was equal 2 years after surgery, suggesting a persistent response. We also identified a response to T across all anatomical severities, including proximal variants, although the greatest response was seen in our distal patients (see Figure).

Limitations

This study did not include surgical outcomes, and therefore we cannot extrapolate that an increase in GW corresponds to a lower complication rate. Our study did include 12 surgeons, which increases variability in T usage and measurement compliance.

Interpretation for Patient Care

Preoperative T administration resulted in a larger GW for boys with hypospadias. This growth was dose dependent and persisted long term, which is important for patients with a relatively smaller glans. Surgeons can use this information to gauge the expected response to T and counsel their patients accordingly. The next step will be to determine the impact of the use of T on surgical complications.