Testosterone prior to hypospadias repair: Postoperative complication rates and long-term cosmetic results, penile length and body height

Summary Introduction The use of hormonal therapy was first described in 1971 before hypospadias surgery, and it has been debated ever since. The long-term outcomes after puberty of patients treated with pre-operative testosterone in childhood are lacking. Objectives Possible long-term effects of testosterone are often asked about in daily practice. The current study investigated the long-term outcomes regarding height, penile length and penile cosmesis in adult men after hypospadias surgery in childhood with and without pre-operative testosterone. Methods Adult men ( n  = 121) who underwent primary hypospadias repair in childhood were included. Pre-operative penile appearance, judged by a paediatric urologist, determined the use of pre-operative testosterone. Data on hypospadias characteristics, healing complications, surgical repair, and testosterone use were collected retrospectively. At adult age, stretched penile length and body height were measured, and penile cosmesis was evaluated using the Pediatric Penile Perception Score (PPPS). Results Postoperative complication rates in patients ( n  = 121) with and without testosterone were similar (50% vs. 43%; P  = 0.54). Sixty adult patients (50%) with a median age of 19.8 years and follow-up time of 18.3 years were examined at the outpatient clinic at adult age. Of this group, testosterone was applied in 12/43 patients with distal, 3/6 patients with midshaft, and 9/11 patients with proximal hypospadias. Adult stretched penile length (12.0 cm vs. 12.4 cm; P  = 0.47) and adult height (180.1 cm vs. 179.0 cm  P  = 0.65) showed no difference between patients with and without testosterone treatment. Penile cosmesis was (very) satisfactory in all PPPS domains, and showed no difference between the testosterone group and the non-testosterone group. Univariate and multivariate analysis was conducted to determine if the hypospadias type or pre-operative testosterone therapy had more influence on the long-term outcomes. None of the long-term outcomes were significantly associated with pre-operative testosterone therapy on multivariate analysis. Discussion This was the first study reporting long-term outcomes of hypospadias patients after puberty who received pre-operative hormonal therapy. Validated instruments were used as much as possible. Shortcomings of this study were the 50% response rate, the retrospective design, and the lack of objective inclusion criteria reported to indicate pre-operative testosterone therapy. Conclusion This study suggested that the long-term results of patients receiving pre-operative testosterone treatment, who often had more challenging hypospadias, were similar to those who did not. However, a randomised controlled study is needed to confirm these results. Summary Table . Outcomes of multivariate regression analysis: impact of hypospadias severity versus pre-operative testosterone use on adult penile length and height, and cosmetic outcome measured by the Pediatric Penile Perception Score (PPPS). Outcome variable Univariate analysis Multiple linear regression Predictor variable Rho P β P CI (95%) Penile length (cm) Hypospadias type −0.48 0.01 −2.9* 0.01 −4.4 to 1.4** Testosterone use −0.11 0.40 0.6 0.32 −0.6 to 1.8 Adult height (cm) Hypospadias type −0.13 0.33 NS Testosterone use −0.34 0.80 NS Outcome variable Univariate analysis Logistic regression Predictor variable Rho P OR P CI (95%) General aspect (PPPS) Dissatisfied vs. satisfied Hypospadias type 0.11 0.41 NS Testosterone −0.07 0.60 NS Hypospadias type ranged from distal (1), midshaft (2) and proximal (3) hypospadias. Testosterone use: no testosterone (0) versus pre-operative testosterone treatment (1). Pediatric Penile Perception Score (PPPS): (very) dissatisfied outcome (0) versus (very) satisfied outcome (1). Rho: Spearman's rank correlation. OR: odds ratio. * outcome for proximal hypospadias (1) compared to the remaining hypospadias subtypes (0). **R 2 , 019.