Aspectos morfológicos do prepúcio de crianças portadoras de hipospádia com e sem o uso de creme de testosterona a 1%

Abstract

The goal of this study is to analyze the different histological features of the foreskins of children with hypospadia, that has and has not recieved application of testosterone cream, and compare them with circumcised patients. The foreskin of 09 circumcised children (G1), 13 children with hypospadia, who did not receive testosterone (G2), and 13 children who received topical 1% testosterone propionate (G3) were included in this study. The histological evaluation of the collagen fiber was done with Picrosirius staining to analyze the density of these fibers. Masson`s trichrome was used evaluate the homogeneity of the collagen fibers and its quantification as their surface density, which was obtained through a videomicroscopy system superimposed with a cycloid arch test system. Elastic fiber density and homogeneity was evaluated with resorcin-fucsin of Weigert. Androgen receptor histochemistry was used to stain intensity and the number of stained cells. With the von Willebrand factor and the same video-microscopy system superimposed with a cycloid arch test system, the number and volume density of the blood vessels was obtained. Picrosirius histochemistry did not show differences among the study groups (p= 0.905). With Masson`s trichrome, testosterone-treated patients (G3) had lower homogeneity (p=0.001) and surface density of the collagen fibers (0.3 ± 0.1 collagen fibers) than those untreated (G2) (0.4 ± 0.1 collagen fibers) (p<0.001). Circumcised children had a denser pattern of elastic fiber distribution (p=0.003), and the elastic fibers were also less homogeneous (p=0.008) than the other groups. The histochemistry for androgen receptor showed a greater staining pattern in children of G1 compared to G3 (p=0.011). Testosterone-treated foreskins (G3) had an increased absolute numbers of blood vessels (8.5 ± 1.3 vessels/field) (p<0.001) and an increased blood vessel volume density (50.5% ± 7.8 vessel/points) compared to untreated subjects (G2) (24.8% ± 8.6 vessel/points) (p<0.001). Topical 1% testosterone propionate produced neovascularization, in absolute numbers and volume density, and reduced fibrous tissue. Treated children had less homogeneous distribution patterns of vessel-surrounding collagen fibers, suggesting a lower maturity of these fibers, with less collagen deposition.