Our Summary

This study is a comprehensive review of previous research into the use of preoperative hormone therapy (PHT) in children who are undergoing a specific type of surgery to correct hypospadias, a birth defect in boys where the opening of the urethra is on the underside of the penis, not at the tip. Despite showing promise for better surgical outcomes, the use of PHT is still uncertain due to a lack of clear evaluation.

In this review, the researchers looked at 25 studies involving 4,094 patients. They found that doctors often use PHT when the penis length is short. The most common dosage for testosterone, a type of hormone used in PHT, was either 2 mg/kg or an empirical 25 mg monthly, and it was administered 2-3 months before surgery. The hormones were found to be effective in improving the development of the penis, with changes usually peaking 2-3 months after starting the therapy.

However, the effects of PHT on surgical complications and side effects were inconsistent, possibly due to differences in hormone sensitivity, the severity of hypospadias, surgical techniques, and dosing schedules. More research is needed to identify the best patient groups, dosage, and method of administration for the best results.

FAQs

  1. What is preoperative hormone therapy (PHT) in relation to hypospadias repair?
  2. How does preoperative hormone therapy (PHT) improve the development of the penis prior to hypospadias surgery?
  3. Why is the effect of PHT on surgical complications and side effects inconsistent?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hypospadias repair is to discuss the option of preoperative hormone therapy with their healthcare provider. It is important to follow the recommended dosage and timing of the therapy to potentially improve surgical outcomes. However, it is also important to be aware that the effects of hormone therapy may vary and more research is needed to fully understand its benefits and risks. It is always best to have an open and honest conversation with your doctor about all treatment options available.

Suitable For

Patients who are typically recommended for hypospadias repair include:

  1. Infants or young children with a severe form of hypospadias that can affect their urinary and sexual function.
  2. Patients with penile curvature or chordee, which can impact the success of the surgery.
  3. Patients with a short penis length, as this may affect the surgical outcomes.
  4. Patients with associated medical conditions that may complicate the surgery, such as hormonal disorders or genetic syndromes.
  5. Patients who have not had previous hypospadias repair surgeries or have had complications from previous surgeries.
  6. Patients who are psychologically impacted by the appearance of their genitalia and would benefit from the surgery for improved self-esteem and quality of life.

It is important for patients and their families to discuss the potential benefits and risks of hypospadias repair with their healthcare provider to determine the best course of treatment.

Timeline

Before hypospadias repair:

  • Patient is diagnosed with hypospadias, a birth defect in boys
  • Patient undergoes evaluations and consultations with a pediatric urologist
  • If deemed necessary, patient may undergo preoperative hormone therapy (PHT) to improve penis development
  • PHT involves the administration of testosterone for 2-3 months before surgery

After hypospadias repair:

  • Patient undergoes surgical repair of hypospadias
  • Recovery period post-surgery, which may involve pain management and wound care
  • Follow-up appointments with the pediatric urologist to monitor healing and address any complications
  • Long-term follow-up to assess outcomes of the surgery and potential need for additional interventions

Overall, the timeline for a patient with hypospadias involves a combination of medical evaluations, surgical intervention, and follow-up care to ensure the best possible outcome.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hypospadias repair, specifically regarding the use of preoperative hormone therapy, may include:

  1. What is the purpose of preoperative hormone therapy in hypospadias repair, and how does it work?
  2. Am I a candidate for preoperative hormone therapy based on my specific condition and needs?
  3. What are the potential benefits of using hormone therapy before surgery for hypospadias repair?
  4. What are the potential risks or side effects associated with preoperative hormone therapy in this context?
  5. How will the dosage and schedule of hormone therapy be determined for my treatment?
  6. How long before the surgery will I need to start hormone therapy, and how long will it continue?
  7. What are the expected outcomes of using hormone therapy in terms of surgical success and overall penis development?
  8. Are there any alternative treatment options to consider instead of or in addition to hormone therapy for hypospadias repair?
  9. What specific follow-up care or monitoring will be needed during and after hormone therapy in preparation for surgery?
  10. Are there any specific research studies or clinical trials on hormone therapy for hypospadias repair that I should be aware of?

Reference

Authors: Di H, Wen Y, Li Y. Journal: J Pediatr Urol. 2023 Jun;19(3):250-260. doi: 10.1016/j.jpurol.2023.01.013. Epub 2023 Jan 20. PMID: 36746717