Biometria do pênis hipospádico após terapia hormonal: testosterona x estradiol – ensaio clínico randomizado duplo cego

Abstract

Introduction: The use of preoperative androgenic hormonal stimulation before surgical correction of hypospadias aims to increase the size of the penis and achieve better surgical results. However, a more objective assessment of systemic and local effects after topical hormonal stimulation is still lacking in the literature. As for estrogens, they are identified as potentiators in the processes of dermal repair and acceleration of wound healing. They act by stimulating the deposition of granulation tissue matrix, causing contraction of the wound and re-epitalization. Therefore, estrogen is considered to be one more resource that can be used to improve the anatomical and tissue conditions of the hypospadic penis, which still remains a great challenge for pediatric surgeons and urologists. Objectives: To evaluate the effects of topical use of testosterone and estradiol in preoperative children with hypospadias on penile measurements (biometrics), side effects and serum hormonal changes. Patients and method: Sixty-nine children with hypospadias completed the study and were divided randomly into three groups: Control Group: 17 children who used moisturizing cream (placebo). Testosterone Group, composed of 28 boys who used propionate of 1% testosterone and Estradiol Group: 24 children who used estradiol 0.01%. Hormone creams and placebo were used topically throughout the penis twice daily for 30 days prior to surgical correction. Verification of side effects and blood dosages (total and free testosterone, estradiol, FSH and LH) were performed before, 30, and 90 days after treatment. Biometric evaluation of the penis was made before and after 30 days of the hormonal stimulus and included measurements of penile length at maximum traction, penile and glans body diameter, distance from the urethral meatus to the tip of the penis and the width of the urethral plate. Results: The mean age of the children was 3, 4 years. Forty-five children had anterior hypospadias (23 coronal and 22 subcoronal), 13 in the midshat, 3 proximal and 8 penoscrotal. A significant increase in penis length, penile and glans diameter were observed after 30 days in the testosterone group (p = 0,0005, p = 0,0094, p = 0,0026, respectively). Children who used estradiol cream 0.01% for 30 days did not show statistically significant changes in any of the penile measurements, as did those in the control group. After 30 days, in the testosterone group, 24/28 (85%) had pubic hair and 21/28 (74%) showed darkening of the genital skin. In the estradiol group, 3/24 (14%)

had pubic hair and 12/24 (50%), darkening of the genital skin. In the evaluation after 90 days of hormonal use, these changes were not persistent in both groups. All the hormonal rates did not present variations with statistical significance and tended to return to the basal level after 90 days. Conclusion: Preoperative use of topical testosterone increased the size and diameter of the glans penis, which did not occur with the use of estradiol. Side effects were transient, with the appearance of pubic hair and darkening of the genital skin the most observed. Significant and persistent hormonal changes were not noted in any of the study groups.