Preoperative treatment with human chorionic gonadotropin in infancy decreases the severity of proximal hypospadias and chordee

Citation
Sa. Koff et Vr. Jayanthi, Preoperative treatment with human chorionic gonadotropin in infancy decreases the severity of proximal hypospadias and chordee, J UROL, 162(4), 1999, pp. 1435-1439
Citations number
7
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
JOURNAL OF UROLOGY
ISSN journal
00225347 → ACNP
Volume
162
Issue
4
Year of publication
1999
Pages
1435 - 1439
Database
ISI
SICI code
0022-5347(199910)162:4<1435:PTWHCG>2.0.ZU;2-I
Abstract
Purpose: We determined whether human chorionic gonadotropin (HCG) pretreatm ent of severe proximal penoscrotal hypospadias and chordee causes sufficien t penile shaft or skin enlargement to enhance surgical repair and improve p atient outcome. Materials and Methods: A total of 12 boys 6 to 12 months old with proximal hypospadias and severe chordee received a course of HCG for 5 weeks immedia tely preceding hypospadias repair. Results: Chordee decreased and penile length increased in all cases (mean i ncrease 94%). Penile length gain was disproportional. Most of the increase in length was proximal to the urethral meatus, which moved the meatus dista lly an average of 11.4 mm. (range 6.0 to 19.0), producing a mean increase o f 586% in the distance between the penoscrotal junction and meatus. In cont rast, there was no statistically significant increase in penile shaft lengt h distal to the urethral meatus. Surgical treatment was facilitated by HCG pretreatment. Three meatal based repairs were performed, only 1 urethral fi stula developed and chordee was corrected by penile degloving only in 8 cas es. Conclusions: HCG pretreatment in infancy produces disproportional penile en largement, which advances the meatus distally to decrease the severity of h ypospadias and chordee. This response pattern simplifies the required surgi cal procedure and appears to improve surgical results. It may benefit selec t patients, and provide insights into the endocrinopathy of hypospadias and the embryopathy of the hypospadias-chordee complex.