| Objective: To apply testosterone cream to children with severe hypospadias with penile dysplasia to smear the penis,and to observe the effect of external use of testosterone cream to penis development 、 sex hormone concentration 、androgen receptor expression and complication rates of Severe hypospadias with penile dysplasia children.Methods: Retrospective analysis in February 2010 to March 2017,the Affiliated Hospital of southwest university,pediatric surgery,the treatment of 132 cases of children with Severe hypospadias with penile dysplasia,aged 2 years to 4 years.Depending on whether two-stage surgery was performed or not and Whether or not to use testosterone cream to spread the penis before surgery,all of the children were divided into four groups: A,B,C,and D.In group A,one-stage surgery in 45 children,who had penile straightening surgery and urethroplasty,and testosterone cream was used to smear the penis before surgery.In group B,two-stage surgery in 28 children,who had penile straightening surgery,while had urethroplasty after 1 year,and testosterone cream was used to smear the penis before one-stage surgery.Children in both groups A and B had 1% testosterone cream that was evenly applied to penis head and penis.Each application lasted for 2 minutes,once each morning and evening,and continuously applied for 30 days.Surgery was performed 30 days after stopping using testosterone cream.In group C,one-stage surgery in 30 children,who had penile straightening surgery and urethroplasty.In group D,two-stage surgery in 29 children,who had penile straightening surgery,while had urethroplasty 1 year after.Children in both groups C and D had no testosterone cream.Penile size of All the children were measure in 2 months before surgery,three days before the first surgery,and one year after the first surgery: including the penis length and diameter.In 2 months before surgery,three days before the first surgery,and one year after the first surgery,serum sex hormones(T,LH,FSH)were determined with radioimmunoassay.There was penis skin from all the children during the first surgery,and the expression of androgen receptor was detected by Immunohistochemical staining.1 month after radical surgery,meanwhile complication rate was compared in all groups,such as urethral fistula,urethral stricture,residual penile curvature,and urethral diverticula.Results: 1.In this research,132 children with severe hypospadias with penile dysplasia were aged 2 years to 4 years,and there was no statistically significant difference in the basic data of age,height and weight between the four groups(P>0.05).2.The penis length and diameter in the four groups: the penis length and diameter of group A and group B in 3 days before the first surgery are higher than that in 2 months before surgery.The penis length and diameter of group A and group B in one year after the first surgery are higher than that in three days before the first surgery.In one year after the first surgery,the penis length and diameter of group B are higher than of group A.And the difference was statistically significant(P<0.05).The penis length and diameter of group C and group D in 3 days before the first surgery are similar than that in 2 months before surgery,and there was no statistically significant difference(P>0.05).The penis length and diameter in one year after the first surgery are higher than that in 3 days before the first surgery,the penis length and diameter of group D are higher than that of group C in one year after the first surgery,and the difference was statistically significant(P<0.05).In 3 days before the first surgery and one year after the first surgery,the penis length and diameter of group A and group B are higher than that of group C and group D,and the difference was statistically significant(P<0.05).3.Serum sex hormones(T,LH,FSH)in the four groups: Sex hormones of group A and group B were compared between in 3 days before the first surgery and 2 months before surgery,T level is significantly increased,LH and FSH are significantly decreased,and the difference was statistically significant(P<0.05).Level of T,LH and FSH of group A and group B in one year after the first surgery are similar than that in 2 months before surgery,and there was no statistically significant difference(P>0.05).The testosterone cream was not applied locally in group C and group D.In 2 months before surgery,3 days before the first surgery and one year after the first surgery,Level of T,LH and FSH of group C and group D are similar,and there was no statistically significant difference(P>0.05).4.Expression of androgen receptors of penile tissue in the four groups: androgen receptors are expressed in penile tissues of the four groups.The testosterone cream was applied locally in group A and group B,while not group C and group D.Expression of androgen receptors in group A and group B are higher than in group C and group D,and the difference was statistically significant(P<0.05).There was no statistically significant difference in expression of androgen receptors between group A and group B,and between group C and group D(P>0.05).5.Complication rate of the four groups in 1 month after radical surgery: there was statistically significant difference in complication rate between the four groups(x2=18.551;P=0.000<0.05).There was no statistically significant difference in complication rate between group A and group B(x2=1.575;P=0.210),and between group B and group D(x2=3.766;P=0.052).The complication rate of group D is lower than that of group C,and the difference was statistically significant(x2=4.901;P=0.027<0.05).The complication rate of group A is lower than that of group C,and the difference was statistically significant(x2=10.938;P=0.001<0.05).conclusion: For children with severe hypospadias and penile dysplasia,external use of testosterone cream before surgery can promote the development of the penis and create favorable conditions for the surgery.The external use of testosterone cream before surgery combined with two-stage surgery can significantly improve the success rate of surgery and reduce complications.The mechanism might be related to the increase of the expression of androgen receptor in penile induced exogenous testosterone. |
PDF Full Text Request