Updated Report on Preoperative Testosterone Hormone Therapy in Hypospadias Reconstruction: Comprehensive Systematic Review and Meta-analysis
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Abstract
Hypospadias is a congenital condition that affects the genital appearance in individuals and requires urethral reconstruction as an effective treatment. However, this surgical intervention is often associated with complications. Recent research has shown that preoperative testosterone therapy can facilitate penile revascularization and lead to successful surgical outcomes. This study aims to investigate the side effects of testosterone therapy and determine the optimal mode of delivery. Materials and methods: A systematic search was conducted in Scopus, PubMed, Cochrane, and ScienceDirect databases until June 10th, 2023. Fourteen articles were selected based on predefined inclusion and exclusion criteria. Quality appraisal of clinical trials comparing preoperative testosterone therapy with control groups in hypospadias patients was evaluated using the Newcastle-Ottawa Scale (NOS). Quantitative analysis was done using RevMan 5.4 and CMA V3. The effect measures were presented as odds ratios (OR) and mean change from baseline with corresponding 95% confidence intervals (CI). Results: The meta-analysis included a total of 15 studies. Preoperative testosterone treatment demonstrated a significant reduction in fistula occurrence (38%) and reoperation rate (55%), indicating its potential to effectively reduce these complications in hypospadias surgery. Moreover, from the mode of testosterone administration, intramuscular administration shows statistically significant preferable preoperative effects in terms of the mean change from baseline of penis length (0.905 vs 0.713), penis diameter (0.494 vs 0.37), and glanular width (0.326 vs 0.254) compared to topical administration. This comprehensive systematic review and meta-analysis confirm the statistical significance of preoperative testosterone therapy in reducing complications such as fistula and reoperation rate in hypospadias surgery. Conclusion: The findings strongly support the recommendation for hormonal treatment before surgery to enhance intraoperative circumstances and optimize the results of hypospadias reconstruction. Testosterone should be considered a valuable option in the preoperative management of hypospadias patients.
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