Long-term Effects of Pre-operative Testosterone and Dihydrotestosterone on Glans Width in Boys With Hypospadias

Abstract

Background: Small glans width is a risk factor for urethroplasty complications. This study aimed to assess and compare short- and long-term effects of two pre-operative topical androgen treatment protocols on maximum glans width. Furthermore, to evaluate post-operative complications when surgery was delayed >3 months following hormonal treatment completion.

Methods: Topical 2.5% dihydrotestosterone (February 2016-July 2018) and 5% testosterone (August 2018-December 2022) treatment protocols, completed >3 months before surgery, were offered to all children with proximal hypospadias and small glans width requiring urethroplasty. Serial glans width measurements were collected prospectively pre- and post-androgen treatment. Demographic data and complications were collected retrospectively.

Results: A significant increase in mean glans width was observed following both dihydrotestosterone (6.1 mm [95% CI 4.3-7.9 mm] pre-dihydrotestosterone to 14.9 mm [13.2-16.6 mm, p < 0.0001] post-dihydrotestosterone in 11 children) and testosterone (10.5 mm [9.9-11.1 mm] pre-testosterone to 14.6 mm [13.7-15.5 mm, p < 0.0001] post-testosterone in 32 children). Serial post-treatment measurements showed no loss of gained width >1 year after treatment completion. Mean increase in glans width from pre-treatment measurement at 0-3 months, 4-12 months and >12 months following treatment was 7 mm (95% CI 3.8-10.2), 9 mm (7.2-10.8) and 10 mm (7.3-12.7) post-dihydrotestosterone and 4.4 mm (95% CI 3.4-5.4 mm), 4.3 mm (3.5-5.2) and 5.1 mm (4-6.2) post-testosterone respectively. Complications were noted in 4/22 patients who received topical androgen prior to initial hypospadias surgery and had completed all surgical stages.

Conclusions: Both treatment protocols produced a significant, sustained increase in glans width. Delaying hypospadias surgery for >3 months following androgen application may circumvent androgen induced vascularity and poor wound healing.

Level of evidence: Level IV.

Type of study: Treatment study.

Keywords: Dihydrotestosterone; Glans width; Hypospadias; Testosterone.