Androgen receptor expression in the foreskin of children born with hypospadias: a systematic review.

Abstract

Hypospadias is a congenital malformation of the penis affecting 1 in every 250 male births. Measurement of androgen receptor (AR) levels in the foreskin has been used to elucidate the role of this receptor in the hypospadias aetiology. This review evaluates the extent of immunohistochemical AR expression in the foreskin of boys with hypospadias, compared to their unaffected counterparts. Several databases (MEDLINE, Embase, and The Cochrane library) were searched to find studies relevant to our research question. From 657 studies, 24 underwent full-text review, and 8 were included in a narrative synthesis analysis of the findings reported by the literature. Four studies reported significantly increased quantified AR expression in hypospadias (p < 0.05), while three described significantly decreased expression (p < 0.013), and one reported no significant difference between groups. Furthermore, AR expression was found to be higher in the stroma of the foreskin than the epithelium. No clear consensus has been established regarding the relationship between AR expression and hypospadias in the literature. This may be due to variability in the age of participants included in the study, or additional factors such as genetic conditions, highlighting the need for a standard approach to investigation. Registration: This systematic review was registered under PROSPERO identification number CRD420251000803.