Our Summary

This research paper looks at the impact of preoperative hormonal stimulation (PHS), typically used to improve the outcomes of hypospadias surgery (a common male birth defect where the opening of the urethra is on the underside of the penis, instead of at the end). The researchers carried out a comprehensive review of existing studies and found that the use of PHS did not significantly affect postoperative outcomes. However, when they only considered high-quality studies, they found that PHS could actually reduce the rate of complications after surgery. The side effects of PHS were generally mild and temporary. The researchers suggest that future studies should focus on identifying which patients would benefit most from PHS and the best way to administer it.

FAQs

  1. What is the purpose of preoperative hormonal stimulation (PHS) in hypospadias surgery?
  2. What were the findings about the impact of PHS on postoperative outcomes from hypospadias surgery?
  3. What are the side effects of PHS and are they permanent?

Doctor’s Tip

A helpful tip a doctor might give a patient about hypospadias repair is to discuss the option of preoperative hormonal stimulation with their healthcare provider. This treatment may help improve surgical outcomes and reduce the risk of complications. It is important to weigh the potential benefits and risks of PHS with your doctor to determine if it is the right choice for you or your child.

Suitable For

Patients with hypospadias, particularly those with more severe forms of the condition, are typically recommended for hypospadias repair surgery. The decision to undergo surgery is often based on factors such as the location and severity of the urethral opening, the presence of chordee (a downward curvature of the penis), and the overall impact of the condition on the patient’s quality of life.

In some cases, preoperative hormonal stimulation (PHS) may be recommended as a way to improve the outcomes of hypospadias repair surgery. PHS involves administering hormones such as testosterone or human chorionic gonadotropin (hCG) before surgery in an attempt to increase penile size, improve tissue quality, and enhance surgical outcomes.

While the use of PHS is not always necessary for all patients with hypospadias, it may be recommended in certain cases where the surgeon believes it could benefit the patient. Patients with more severe forms of hypospadias, particularly those with inadequate penile size or tissue quality, may be more likely to be recommended for PHS prior to surgery.

Ultimately, the decision to undergo hypospadias repair surgery, with or without PHS, should be made in consultation with a qualified pediatric urologist or surgeon who can assess the individual patient’s specific needs and recommend the most appropriate treatment plan.

Timeline

Before hypospadias repair:

  • Patient is diagnosed with hypospadias during infancy or childhood
  • Patient undergoes preoperative evaluations to assess the severity of the condition and determine the best treatment plan
  • In some cases, the patient may undergo preoperative hormonal stimulation to improve surgical outcomes

After hypospadias repair:

  • Patient undergoes surgical repair of the hypospadias, which involves repositioning the urethral opening to the tip of the penis
  • Patient may experience pain, swelling, and discomfort in the days following surgery
  • Patient may need to wear a catheter for a period of time to help with urine drainage
  • Patient will have follow-up appointments with their healthcare provider to monitor healing and address any complications
  • Long-term outcomes of hypospadias repair may include improved urinary function, sexual function, and cosmetic appearance of the penis.

What to Ask Your Doctor

  1. What is hypospadias and why is surgery necessary to repair it?
  2. What are the potential risks and complications associated with hypospadias repair surgery?
  3. What is preoperative hormonal stimulation (PHS) and how does it work to improve outcomes?
  4. What are the potential benefits of using PHS for hypospadias repair surgery?
  5. Are there any specific criteria that make a patient a good candidate for PHS?
  6. What are the potential side effects of PHS and how long do they typically last?
  7. How is PHS administered and what is the typical timeline for treatment before surgery?
  8. How will PHS affect the overall success and outcome of the surgery?
  9. Are there any alternative treatments or approaches to consider instead of PHS?
  10. What questions should I ask or information should I provide during follow-up appointments to monitor the effectiveness of PHS before surgery?

Reference

Authors: Chua ME, Gnech M, Ming JM, Silangcruz JM, Sanger S, Lopes RI, Lorenzo AJ, Braga LH. Journal: J Pediatr Urol. 2017 Oct;13(5):470-480. doi: 10.1016/j.jpurol.2017.06.019. Epub 2017 Jul 29. PMID: 28939350