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
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.