Our Summary

Hypospadias is a birth defect in boys where the opening of the urethra is not located at the tip of the penis. In some cases, doctors use preoperative androgen stimulation (PAS) to prepare the patient for hypospadias repair surgery. However, existing studies on this topic have several limitations, including small sample sizes, which make the results unreliable. The researchers in this study used a metric called the Fragility Index (FI) to examine the quality of these studies. The FI measures how many extra events (like complications from surgery) would need to happen to change a study’s results from statistically significant to not significant.

The researchers looked at studies conducted between 1990 and 2020 that examined the effect of PAS on complications after hypospadias repair surgery. They found 14 studies that met their criteria. The researchers determined that the results from these studies were mixed and unreliable. Some studies suggested that PAS increased the risk of complications, while others did not. The researchers concluded that more well-designed studies are needed to truly understand the effect of PAS on hypospadias repair surgery.

FAQs

  1. What is hypospadias and how is it treated?
  2. What is preoperative androgen stimulation (PAS) and how is it used in hypospadias repair surgery?
  3. Why are the current studies on the effect of PAS on hypospadias repair surgery considered unreliable?

Doctor’s Tip

In the meantime, it is important for patients undergoing hypospadias repair surgery to follow their doctor’s post-operative instructions carefully. This may include keeping the surgical site clean and dry, avoiding strenuous activity, and taking any prescribed medications as directed. It is also important for patients to attend all follow-up appointments with their healthcare provider to monitor for any complications and ensure proper healing. If any concerns or complications arise, it is important to contact your healthcare provider immediately for further guidance.

Suitable For

Overall, patients with hypospadias who are recommended for surgery are typically those who are experiencing symptoms such as difficulty with urination, abnormal spray during urination, or curvature of the penis. Additionally, patients with more severe forms of hypospadias, such as those with a significant displacement of the urethral opening, may also be recommended for surgery to correct the condition. Ultimately, the decision to undergo hypospadias repair surgery is made on a case-by-case basis by a healthcare provider in consultation with the patient and their family.

Timeline

Before hypospadias repair:

  • Diagnosis of hypospadias at birth
  • Consultation with a pediatric urologist to discuss treatment options
  • Possible use of preoperative androgen stimulation to prepare for surgery
  • Preoperative tests and evaluations to assess the severity of the condition

After hypospadias repair:

  • Surgery to correct the position of the urethral opening
  • Postoperative care and monitoring to prevent complications such as infection or narrowing of the urethra
  • Follow-up appointments with the urologist to monitor healing and assess long-term outcomes
  • Possible need for additional surgeries or procedures to address any complications or improve cosmetic appearance

Overall, the timeline for a patient with hypospadias includes a combination of preoperative preparation, surgical intervention, and postoperative care to achieve the best possible outcome for the patient.

What to Ask Your Doctor

  1. What is hypospadias repair surgery and why is it necessary for my child?

  2. What is preoperative androgen stimulation (PAS) and how does it work in preparing for hypospadias repair surgery?

  3. What are the potential benefits of using PAS before hypospadias repair surgery?

  4. What are the potential risks or complications associated with using PAS before hypospadias repair surgery?

  5. How will you determine if PAS is appropriate for my child’s case?

  6. What is the success rate of hypospadias repair surgery with or without PAS?

  7. Are there any alternative treatments or approaches to hypospadias repair surgery that we should consider?

  8. What is the expected recovery process and timeline for my child after hypospadias repair surgery with or without PAS?

  9. How will you monitor my child’s progress and address any potential complications post-surgery?

  10. Are there any ongoing research studies or clinical trials related to hypospadias repair surgery and PAS that we should be aware of?

Reference

Authors: Li B, Kong I, McGrath M, Farrokhyar F, Braga LH. Journal: J Pediatr Urol. 2021 Oct;17(5):661-669. doi: 10.1016/j.jpurol.2021.07.027. Epub 2021 Aug 9. PMID: 34518122