Potential of Preoperative Testosterone Stimulation Therapy to Reduce Complication in Hypospadias Repair: A Systematic Review and Meta-Analysis

Abdul Munawwir; Fikri Akbar Mustamar; Muhammad Asykar Palinrungi; Aristo Aristo

doi:10.11594/bjurology.2025.006.01.4

Authors

Abdul Munawwir Tadulako University Hospital, Palu, Central Sulawesi, Indonesia, 94118
Fikri Akbar Mustamar La Palaloi General Hospital, Maros, South Sulawesi, Indonesia, 90513
Muhammad Asykar Palinrungi Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, 90245
Aristo Aristo Division of Urology, Department of Surgery, Faculty of Medicine, Tadulako University, 94117

DOI:

https://doi.org/10.11594/bjurology.2025.006.01.4

Keywords:

hypospadia, improve, outcome, repair, testosterone

Abstract

Introduction. The pre-operative hormone stimulation is recommended for hypospadias patients, especially those with small penis, to improve the results and outcomes of hypospadias repair. We conducted a systematic review and meta-analysis to evaluate the effectiveness of pre-operative testosterone stimulations before hypospadias repair.

Methods. We performed a comprehensive search for relevant studies from PubMed, Medline, Cochrane, Proquest, and Embase from August 2000 until August 2023 . The phrases "hypospadias" and "testosterone treatment" were utilized. Only studies focusing on patients diagnosed with hypospadias were considered. This analysis exclusively included English-language papers, randomized control trials, cohort studies, and case-control studies. Case studies without comparable groups were excluded. Editorials, comments, and review articles were excluded from the study. We used the PRISMA guidelines for this systematic review and meta-analysis report. RevMan version 5.4.1 was used to analyze and evaluate the data.

Results. A total of 832 patients undergoing urethroplasty were evaluated in 7 studies. A total of 372 patients were categorized into the intervention group, which received testosterone hormone therapy (parenteral, intramuscular, and topical). Patients who receive preoperative testosterone therapy have a 0.68 reduced risk of complications rate compared to those who did not (P = 0.03, I2 = 28%, CI: 0.68, OR: 0.48 - 0.96), reduced meatal stenosis (P = 0.04, OR: 0.66, 95% CI: 0.44 - 0.98, I2 = 28), reduced the risk of postoperative glans dehiscence (P = 0.0004, OR: 0.46, 95% CI (0.30-0.71), I2 = 57%), and reduced risk of fistula urethrocutaneous (P = 0.03, OR: 0.58, 95% CI: 0.36 - 0.94, I2 = 22%).

Conclusion. Pre-operative testosterone stimulation can improve surgical outcomes. Complication rates, such as meatal stenosis, glans dehiscence, and fistula, showed a significant effect in patients who intervened with testosterone stimulation pre-hypospadias repair.

Keywords: hypospadia, improve, outcome, repair, testosterone

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