Preoperative hormonal stimulation in hypospadias: a systematic review

Introduction: Preoperative hormonal stimulation with testosterone or estrogen is an emerging treatment modality for hypospadias, which can potentially improve surgical outcomes and reduce the risk of complications. This review aims to evaluate the current knowledge on preoperative hormonal stimulation in hypospadias. Methods: This study was a combination of a systematic review followed by a meta-regression analysis performed on PubMed, Google Scholar, DOAJ, and Cochrane. The study included randomized controlled trials, prospective and retrospective cohort studies, and before-and-after studies with or without control. The search was performed in English and was limited to articles published between January 1, 2000, and December 31, 2020. Results: The database search yielded 188 articles, which were systematically eliminated, leaving 15 relevant articles. The analyzed articles showed that testosterone is the most commonly used hormonal treatment in hypospadias, followed by dihydrotestosterone (DHT) and estrogen. Testosterone may be given in topical, parenteral, or oral formulations, while DHT is most often used in topical form. Conclusions: Preoperative stimulation with testosterone or DHT is associated with increased penile length and glans circumference before surgery, which may ease the reconstruction process. In addition, testosterone and DHT increase the rate of neovascularization and reduce the risk of postoperative complications.