Abstract
Objective: We report preoperative testosterone stimulation based on glans width measurements in patients with midshaft and proximal hypospadias, revealing androgen resistance in those with proximal hypospadias.
Methods: Patients had maximum glans width measured preoperatively. Those < 14 mm initially received 2 mg/kg testosterone cypionate intramuscularly for two to three doses, with the aim of increasing glans width >= 15 mm. Not all patients achieved targeted growth, and some were subsequently treated with escalating doses of testosterone.
Results: 5/15 midshaft patients had two to three doses of 2 mg/kg testosterone, with all increasing glans width to >= 15 mm. 29/47 proximal patients had testosterone, with 13 (57%) not reaching desired glans width. Six of these and another six patients had escalating doses from 4 to 32 mg/kg testosterone, with 11 then achieving targeted glans width. Relative androgen resistance was found in 19/29 (66%) proximal cases, including all treated patients with perineal hypospadias.
Conclusions: 39/62 (63%) patients met objective criteria for preoperative testosterone stimulation based on glans width < 14 mm, which is less than the average normal newborn glans diameter. Evidence of relative androgen resistance was found in 19 (49%), all with proximal hypospadias. Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.