ESPE Abstracts

Background: Hypospadias is one of the most common congenital anomalies in males. Surgical repairing aims to improve the aesthetic and functional outcome. The success rate of hypospadias repairing is variable according to the severity of the malformation with a complication rate(CR) of almost 60% in proximal forms. Testosterone treatment before surgery is still controversial and its impact on surgical outcomes, and the best regimen for administration, is unclear. This study aims to evaluate the penile tissue response and the surgical short-term outcomes in patients with severe hypospadias treated with preoperative transdermal testosterone(TT).

Methods: Medical and surgical records of patients treated with TT before hypospadias repairing between December 2020 and February 2023 were reviewed. Patients with proximal or midshaft hypospadias with glans circumference(GC)<14 mm and/or clinically relevant ventral curvature at preoperative assessment were included. Daily treatment with topical testosterone gel (2%) at a standard dose of 2 mg/day was administered in all patients for 30 to 60 days, according to the clinical response. Penile length (PL), GC and secondary effects of testosterone treatment (painful erection, scrotal hyperpigmentation, pubic hair, skin irritation) were recorded before and after therapy by the same Pediatric Endocrinologist. All patients were treated by the same surgeon who also checked for short term post-operative complications. Data are expressed as mean ± standard deviation (SD).

Results: Ten patients (aged 2.67 ± 1.60 years) were included: 4 (40%) with mid-shaft and 6 (60%) with proximal hypospadias. The mean interval between the topical testosterone stimulation and the surgical intervention was 52 ± 23 days. A two-stage repair was performed in 5 patients with Bracka (20%), Duckett (10%) or TIP technique (20%), while the others underwent a single stage repair with TIP technique. TT prior to the first surgical time was performed in 80% of the cases. No secondary due to the hormonal treatment were reported. A mean increase of 0.76 ± 0.27 cm (+37%) for PL and of 0.42 ± 0.26 cm (+ 40%) for GC were measured. Urethrocutaneous fistula or glandular dehiscence were reported in three patients with proximal hypospadias (50%), while no short-term surgical complications were developed in mid-shaft cases, with a CR of 30% in the overall population.

Conclusions: In our experience, TT is a noninvasive and well-accepted treatment which might help improving hypospadias surgical repair outcome. Standardised dosing protocols and randomized controlled trials are necessary to confirm these preliminary results and to develop future treatment guidelines.