95 / 330
95
19–22 APRIL, 2017, BARCELONA, SPAIN
12:20–12:30
Discussion
S8-9 (P without presentation)
PREOPERATIVE HORMONAL STIMULATION
FOR HYPOSPADIAS REPAIR: AN UPDATED SYSTEMATIC
REVIEW
Roberto IGLESIAS LOPES
1
, Michael CHUA
1
, Michele GNECH
2
, Jessica MING
1
,
Jan Michael SILANGCRUZ
3
, Stephanie SANGER
2
, Joana DOS SANTOS
1
, Armando
Jose LORENZO
1
and Luis H BRAGA
2
1) The Hospital for Sick Children, University of Toronto, Division of Urology, Department of Surgery, Toronto, CANADA
- 2) McMaster Children’s Hospital and University, Division of Urology, Department of Surgery, Hamilton, CANADA -
3) St Luke’s Medical Center, Division of Urology, Department of Surgery, Quezon City, PHILIPPINES
PURPOSE
Preoperative hormonal stimulation (PHS) by giving testosterone or a similar medication is com-
monly used to improve hypospadias repair outcomes. Our objective was to systematically evaluate
the effect of PHS on postoperative complications rates following hypospadias repair.
MATERIAL AND METHODS
Comprehensive literature search was made on April 2016 for OVID MEDLINE, EMBASE, Web of
Science, Cochrane Library, Clinicaltrial.gov, World Health Organization (WHO) International Clinical
Trial Registry Platform (ICTRP) and Proquest. Study quality assessment was done according to
Cochrane collaboration recommendation using risk of bias assessment, ROBINS-I and NOQAS.
Effect estimates were extracted as relative risk (RR) with 95% confidence interval (CI) and pooled
using Mantel-Haenzel method. Evidence quality was assessed using GRADE approach. Twenty-
two publications from 17 trials that examine the effect of PHS on post-operative outcome were
included.
RESULTS
Subgroup analysis according to study design, showed that ten cohort studies with moderate to high
risk of bias for patient selection, showed that PHS have no significant effect on post-operative out-
come (RR 1.23, 95%CI 0.96, 1.58). While pooled effect estimates with moderate quality of evidence
from three RCTs showed that significant lesser post-operative complication occurrence among
patient with PHS (RR 0.36, 95%CI 0.20, 0.65). Described by all included studies, the reported
adverse effects related to PHS were mild and transient with good tolerance.
CONCLUSIONS
Moderate evidence supports the use of PHS as a means to decrease post-operative complication
of hypospadias repair. Future studies should aim at standardizing the dose and mode of delivery
for best clinical result.