Ali Md Mokarram
Department of Pediatric Surgery, Pt BDS PGIMS, Rohtak, Haryana, India.
Afr J Paediatr Surg. 2024 Oct 1;21(4):228-231. doi: 10.4103/ajps.ajps_160_22. Epub 2024 Mar 14.
Severe or proximal hypospadias is associated with inadequate local tissue and small phallus size. Pre-operative androgens have been used to increase phallus size, but there are very few studies on its role in proximal hypospadias. This study aimed to assess the effects of pre-operative intramuscular (IM) testosterone on proximal penile hypospadias in terms of penile morphology and tissue characteristics of penile skin.
This prospective observational study was conducted on 27 patients of proximal hypospadias over a period from June 2017 to July 2018. The patients were sequentially enrolled into two groups: Group A and Group B. Group A patients received IM testosterone before surgery, whereas Group B patients were operated without pre-operative testosterone. Outcomes were analysed in terms of change in penile dimensions and effect on vascularity of penile skin.
Pre-operative IM testosterone in Group A caused a significant increase in stretched penile length from a mean of 3.058 cm (±0.691) to 3.9 cm (±0.875) ( P = 0.002), penile circumference from a mean of 4.142 cm (±0.772) to 4.667 cm (±1.174) ( P = 0.029) and glans width from a mean of 1.225 cm (±0.245) to 1.750 cm (±0.571) ( P = 0.002). There was higher microvessel density in the preputial skin of Group A (mean: 12.212 [±4.745] blood vessels/high-power field [HPF]) compared to Group B (8.867 [±3.258] blood vessels/HPF) ( P = 0.043).
Pre-operative testosterone in proximal hypospadias causes significant changes in penile dimensions and tissue characteristics. Improvement in penile dimensions leads to ease in operability and better tissue handling. However, more studies with large sample size are required to establish the beneficial effects of pre-operative hormone stimulation on urethroplasty.
重度或近端尿道下裂与局部组织不足和阴茎短小有关。术前使用雄激素可增大阴茎尺寸，但关于其在近端尿道下裂中的作用的研究非常少。本研究旨在评估术前肌内注射睾酮对近端阴茎尿道下裂阴茎形态和阴茎皮肤组织特征的影响。
本前瞻性观察性研究于2017年6月至2018年7月期间对27例近端尿道下裂患者进行。患者被依次分为两组：A组和B组。A组患者在手术前接受肌内注射睾酮，而B组患者未接受术前睾酮治疗。根据阴茎尺寸的变化和对阴茎皮肤血管的影响来分析结果。
A组术前肌内注射睾酮使阴茎拉伸长度从平均3.058 cm（±0.691）显著增加至3.9 cm（±0.875）（P = 0.002），阴茎周长从平均4.142 cm（±0.772）增加至4.667 cm（±1.174）（P = 0.029），龟头宽度从平均1.225 cm（±0.245）增加至1.750 cm（±0.571）（P = 0.002）。与B组（8.867 [±3.258]个血管/高倍视野[HPF]）相比，A组包皮皮肤中的微血管密度更高（平均：12.212 [±4.745]个血管/HPF）（P = 0.043）。
近端尿道下裂患者术前使用睾酮会导致阴茎尺寸和组织特征发生显著变化。阴茎尺寸的改善使手术操作更容易且组织处理更好。然而，需要更多大样本研究来确定术前激素刺激对尿道成形术的有益效果。
