ORLANDO, FL USA (UroToday.com) - A popular conundrum that is frequently discussed at meetings of pediatric urologists is whether androgen supplementation impacts healing during hypospadias surgery. Dr. Matthias Hofer designed a study in rats in an effort to address this question. His work was recognized as exemplary and thus included in the competition for the basic science research prize.
He used 30 male castrated Sprague Dawley rats and administered testosterone cypionate every 2 weeks in half of them. Androgen levels were monitored with ELISA. All of the animals underwent a urethroplasty procedure analogous to a hypospadias surgery in a child. The rats were sacrificed at post-operative days 5, 10, and 20 to assess wound healing.
Although testosterone increased penile length and shortened operative times by about 3 minutes, elevated neutrophil and macrophage counts were found through post-operative day 20. Furthermore, myofibroblasts and vessel counts remained elevated for a prolonged period of time in testosterone-supplemented rats, but these counts were actually lower than testosterone-naïve rats on post-operative day 5 when the proliferative phase of wound healing is important.
Dr. Hofer concludes that androgen supplementation may increase and prolong the inflammatory response and thus delay wound healing. This has implications for androgen supplementation prior to hypospadias surgery in pre-pubertal boys. Although it’s possible that testosterone supplementation, if properly timed, may produce the benefits of increased penile size without interfering with wound healing if allowed to “wash out” prior to intervention, that timing is not yet defined. There continues to be broad variability in method of application, timing prior to surgery, and dose. However, it is becoming clear that androgens can have a deleterious effect on healing if exposure occurs near the time of a surgical injury. This ought to be yet another reason to collaborate among institutions to standardize an approach and study the results systematically.
Presented by Matthias Hofer, MD at the Society for Pediatric Urology (SPU) Annual Meeting held concurrently with the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Northwestern University, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL USA
Written by Michaella Prasad, MD of the Medical University of South Carolina, Charleston, and medical writer for UroToday.com