The efficacy of dihydrotestosterone transdermal gel before primary hypospadias surgery: a prospective, controlled,
Cevdet Kaya1, J Bektic, C Radmayr
1Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Insights
Pretreatment with dihydrotestosterone (DHT) gel improved hypospadias repair outcomes. DHT gel reduced complications like glanular dehiscence and scarring, leading to better cosmetic results and fewer reoperations.
Area of Science:
- Pediatric Urology
- Andrology
- Surgical Outcomes
Background:
- Hypospadias repair is a common pediatric urological procedure.
- Optimizing surgical outcomes and minimizing complications are critical.
- The role of androgens in tissue healing and development is well-established.
Purpose of the Study:
- To evaluate the efficacy of transdermal dihydrotestosterone (DHT) gel as a preoperative treatment for hypospadias repair.
- To assess the impact of DHT on reducing postoperative complications and improving cosmetic results in children with primary hypospadias.
Main Methods:
- A randomized controlled trial involving 75 children with primary hypospadias.
- Group 1 (37 children) received daily 2.5% transdermal DHT gel for 3 months preoperatively.
- Group 2 (38 children) received no preoperative treatment.
- All patients underwent tubularized incised plate urethroplasty.
- Outcomes, including fistulas, strictures, dehiscence, and scarring, were assessed at 1-year follow-up.
Main Results:
- The DHT group showed a significant reduction in glanular dehiscence (0% vs. 8%) and moderate to severe scarring (5% vs. 42%) compared to the control group.
- Reoperation rates were significantly lower in the DHT group (3% vs. 24%).
- While not statistically significant, the DHT group had fewer urethrocutaneous fistulas (3% vs. 11%) and meatal stenosis (0% vs. 5%).
Conclusions:
- Preoperative transdermal dihydrotestosterone (DHT) gel is effective in improving outcomes following hypospadias repair.
- DHT treatment significantly reduces complications such as glanular dehiscence and scarring.
- The use of DHT gel leads to improved cosmetic results and a decreased need for reoperation in pediatric hypospadias surgery.
Purpose:
We sought to evaluate the efficacy of transdermal dihydrotestosterone treatment based on the results of hypospadias repair in children with primary hypospadias.
Materials And Methods:
A total of 75 randomized consecutive children who were a mean of 33.4 +/- 3.7 months old and had primary hypospadias were included in the study between September 2004 and April 2006. While 37 children were treated with 2.5% transdermal gel daily, applied directly onto the penile shaft and glans for 3 months (group 1), 38 children did not receive any treatment preoperatively (group 2). All children underwent hypospadias repair using tubularized incised plate urethroplasty. Postoperative complications were analyzed using the Mann-Whitney U test with respect to fistulas, urethral strictures, diverticula, meatal stenosis, glanular dehiscence and scar formation according to the results at 1-year followup.
Results:
Mean ages of the children in groups 1 and 2 were similar (30.8 +/- 5.4 months and 35.1 +/- 5.1 months, respectively). The urethral meatus was coronal in 70%, penile in 24% and penoscrotal in 5% of the patients in group 1, while it was coronal in 84% and penile in 16% of the patients in group 2. Postoperative complications included urethrocutaneous fistula in 4 patients (11%) in group 2, compared to 1 patient (3%) in group 1 (p >0.05). While 3 patients (8%) in group 2 had glanular dehiscence, no patient in the dihydrotestosterone group had this complication (p <0.05). There were 2 patients with meatal stenosis in group 2 (5%), and no patient with meatal stenosis in group 1 (p >0.05). In addition, there were 16 patients (42%) with moderate to severe postoperative scar formation in group 2, compared to only 2 patients (5%) in the dihydrotestosterone group (p <0.05). Finally, there was a significant difference between the overall reoperation rates of group 2 (9 patients, 24%) and group 1 (1 patient, 3%, p <0.05). None of our patients had signs or symptoms of urethral stricture or urethral diverticulum.
Conclusions:
Pretreatment with dihydrotestosterone transdermal gel was effective in decreasing the complications and improving the cosmetic results after hypospadias repair.
