Preoperative topical estrogen application in the management of hypospadias: a systematic review

Area of Science:

• Pediatric Urology
• Endocrinology
• Surgical Complications

Background:

• Hypospadias repair in children often involves urethroplasty.
• Conventional testosterone therapy is sometimes used, prompting exploration of alternatives like local estrogen therapy.
• Estrogen's potential role in improving surgical outcomes and penile growth is under investigation.

Purpose of the Study:

• To evaluate the efficacy of preoperative topical estrogen stimulation in reducing post-urethroplasty complications.
• To assess the impact of estrogen therapy on penile dimensions in pediatric hypospadias patients.
• To synthesize evidence from randomized controlled trials (RCTs) on estrogen use in hypospadias surgery.

Main Methods:

• Systematic literature search across multiple databases for RCTs.
• Inclusion criteria: RCTs involving topical estrogen in patients under 18 years with hypospadias.
• PRISMA guidelines for article selection and JBI critical appraisal tool for bias assessment.

Main Results:

• Four RCTs with a total of 387 patients (174 in the estrogen group) were included.
• Studies used topical estrogen with varying formulations and application timings.
• No significant changes in penile dimensions or postoperative complications were observed with topical estrogen.

Conclusions:

• Current evidence suggests topical estrogen does not improve penile dimensions or reduce complications after hypospadias urethroplasty.
• Variations in study design and outcome reporting limit definitive conclusions.
• Further investigation, including animal and human studies, is warranted to explore estrogen's wound-healing potential in hypospadias.