ECEESPE2025 ePoster Presentations Reproductive and Developmental Endocrinology (128 abstracts)
Efficacy of preoperative hormonal treatment in severe cases of hypospadias: a case-control study
Laura Lucaccioni 1 , Anna Insalaco 2 , Viola Trevisani 1 , Sara Vandelli 2 , Beatrice Pellesi 3 , Filippo Ghidini 4 , Chiara Sartori 5 , Francesca Poluzzi 6 , Paolo Repetto 6 , Pier Luca Ceccarelli 6 & Lorenzo Iughetti 1
1Department of medical and surgical science of the mother, children and adults, University of Modena and Reggio Emilia, Modena, Italy; 2Post graduate school of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy; 3Medical School, University of Modena and Reggio Emilia, Modena, Italy; 4Service de Chirurgie Pediatrique, Hopitaux Civils de Colmar, Colmar, France; 5Department of Pediatrics, AUSL IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; 6Surgical Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
JOINT3664
Background: Severe proximal hypospadias repair remains a surgical challenge due to the elevated risk of complications. Success rates vary according to the severity of the malformation, with glans width (GW) < 14 mm recognised as an independent risk factor for poor outcomes. Preoperative hormonal treatment (PHT) has been proposed to enhance penile size and improve tissue quality prior to surgery, although its efficacy and the optimal regimen of administration remain controversial. This case-control study evaluates the efficacy of a tailored PHT regimen in patients with severe hypospadias and compares surgical outcomes between patients who received PHT and those who did not.
Methods: A retrospective study of the medical records of patients with proximal (PXH) or midshaft (MSH) hypospadias who underwent surgical repair in the same centre between August 2001 and May 2024. Since June 2020 patients with GW<14 mm and/or significant ventral curvature (>30°) at preoperative assessment received PHT as daily treatment with 2% transdermal testosterone gel(2 mg/day) for 30–60 days, except for one patient who received topical androstanolone 2.5% due to 5alpha-reductase deficiency. Hormonal treatment was discontinued at least 1 month prior to surgery(mean 55±23 days). Penile length(PL), GW, and adverse effects were recorded pre- and post-treatment by the same Paediatric Endocrinologist. Surgical outcomes and short-term postoperative complications were assessed by the same surgeon.
Results: A total of 42 patients were included: 14 received PHT (5 MSH, 9 PXH) and 28 no-PHT (10 MSH, 18 PXH). Mean age at surgery was 2.68±1.75 and 2.09±1.13 years, respectively (p:0.38). In the PHT group no adverse effects due to the hormonal treatment were reported. A mean increase of 45±27mm(+50%) for GW and of 80±42mm(+41%) for PL were measured, with a relevant Cohen’s effect size for both parameters(d=0.75 and d=1.10, respectively). The overall complication rate (CR) between the two groups was 66% in PHT (urethrocutaneous fistula 78%, glandular dehiscence 22%) and 71% in no-PHT (urethrocutaneous fistula 75%, glandular dehiscence 15%, urethral stenosis 15%) (p:0.4), over a mean follow-up period of 31±15 months. For MSX cases, CR was 20% for PHT while 50% for no-PHT.
Conclusions: PHT was found to be a non-invasive, well-accepted, and effective treatment for enhancing penile size prior to surgical repair of severe hypospadias. Although a direct impact on complication rates could not be established for PXH, due to the reduced sample size, the improvement in MSX cases is significant.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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