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JU INSIGHT Does Preoperative Testosterone Reduce Complications in Distal Hypospadias Repair With Urethroplasty?
By: Karl F. Godlewski, MD, Children’s Hospital of Philadelphia, Pennsylvania; Sameer Mittal, MD, MSc, Children’s Hospital of Philadelphia, Pennsylvania; Nathan Hyacinthe, Children’s Hospital of Philadelphia, Pennsylvania; Katherine Fischer, MD, Children’s Hospital of Philadelphia, Pennsylvania; John Weaver, MD, MSTR, Rainbow Babies and Children’s Hospital, Cleveland, Ohio; Jason Van Batavia, MD, MSTR, Children’s Hospital of Philadelphia, Pennsylvania; Dana Weiss, MD, Children’s Hospital of Philadelphia, Pennsylvania; Arun Srinivasan, MD, Children’s Hospital of Philadelphia, Pennsylvania; Aseem Shukla, MD, Children’s Hospital of Philadelphia, Pennsylvania; Stephen Zderic, MD, Children’s Hospital of Philadelphia, Pennsylvania; Thomas Kolon, MD, Children’s Hospital of Philadelphia, Pennsylvania; Mark Zaontz, MD, Children’s Hospital of Philadelphia, Pennsylvania; Christopher Long, MD, Children’s Hospital of Philadelphia, Pennsylvania | Posted on: 30 Aug 2023
Godlewski KF, Mittal S, Hyacinthe N, et al. Does preoperative testosterone administration decrease complications in distal hypospadias repair with urethroplasty?. J Urol. 2023;210(2):352-359.
Study Need and Importance
Despite its use for decades, androgen stimulation prior to hypospadias repair remains controversial. This is likely due to the lack of granularity in prior studies on technical details and patient characteristics, which limits their ability to identify subgroups that may exhibit greater benefit from androgen stimulation. Once driven solely by the meatal location, phenotype considerations have expanded to include the degree of curvature, depth of glans groove, quality of the urethral plate and shaft skin, and glans width (GW). These features present a challenge to reconstruction and dictate surgical repair type and whether preoperative androgen stimulation is considered.
What We Found
In this study on distal hypospadias repairs utilizing urethroplasty we collected a broad array of characteristics, including procedure type, testosterone administration status, GW changes, urethroplasty length, and postoperative complications. We specifically excluded patients who did not undergo a formal urethroplasty as our data indicated a much lower complication rate and, in theory, less of an indication for testosterone. In total, 368 patients met inclusion criteria, of whom 133 did and 235 did not receive testosterone. In both groups the majority of patients underwent a Thiersch-Duplay repair. On multivariable regression we found that after accounting for initial GW, urethroplasty length, and age at surgery, testosterone administration was associated with a reduced risk of postoperative complication (OR 0.4, P = .039). Furthermore, smaller glans width and longer urethroplasty length were associated with increased odds of complication (see Figure).
Limitations
Despite this study being robust in its detailed data collection and sample size, it has limitations, including the retrospective design, differences in baseline patient characteristics, and surgeon bias with regard to testosterone administration and repair type.
Interpretation for Patient Care
In our hands there appears to be a benefit to testosterone administration when a Thiersch-Duplay repair is performed, theoretically by increasing the width of the glans and decreasing tension on the urethra and glans closure, particularly for those with a narrow plate.
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