Arya Srisadono, Cennikon Pakpahan, Tjahjo Djojo Tanojo

Pemberian testosteron praoperasi pada hipospadia: penting atau tidak? laporan kasus

Introduction

Pemberian testosteron praoperasi pada hipospadia: penting atau tidak? laporan kasus. Pelajari efektivitas testosteron praoperasi pada hipospadia untuk meningkatkan hasil bedah, vaskularisasi penis, dan mengurangi komplikasi. Laporan kasus ini menyoroti perbaikan dimensi penis.

Abstract

Background: Hypospadias is a congenital anomaly for which surgical correction remains the definitive treatment. Surgical outcomes are strongly influenced by the timing of intervention and the severity of the malformation, both of which contribute to the risk of postoperative complications. Preoperative administration of testosterone has been proposed as an adjunctive measure to improve operative success by enhancing penile vascularization, increasing glans diameter, and augmenting penile length. Case Presentation: We report the case of a 22-month-old male diagnosed with penoscrotal hypospadias who had previously undergone a cordectomy at 20 months of age. The patient was treated with intramuscular testosterone injections (Sustanon™) at a dose of 25 mg monthly for four months. He was subsequently scheduled for a second-stage surgical repair within three months and was prescribed an additional course of testosterone injections at 25 mg every three weeks for another three months. Following this regimen, penile circumference (PC), flaccid penile length (FPL), and stretched penile length (SPL) increased from 2.5 cm, 2.5 cm, and 3.0 cm to 3.0 cm, 3.2 cm, and 4.0 cm, respectively. Conclusion: Surgical repair of hypospadias remains associated with anatomical and functional risks. Preoperative testosterone therapy may represent a beneficial strategy to optimize surgical outcomes through improved vascularization, increased glans size, and enhanced penile length, thereby potentially reducing the incidence of postoperative complications. The principal limitation of this case report is the incomplete availability of postoperative follow-up data. Latar Belakang: Hipospadia merupakan kelainan kongenital pada penis yang terapi definitifnya adalah tindakan pembedahan. Hasil pembedahan sangat dipengaruhi oleh waktu intervensi serta tingkat keparahan malformasi, yang keduanya berkontribusi terhadap risiko komplikasi pascaoperasi. Pemberian testosteron praoperatif telah diusulkan sebagai terapi tambahan untuk meningkatkan keberhasilan operasi melalui peningkatan vaskularisasi penis, pembesaran glans, serta pertambahan panjang penis. Presentasi Kasus: Kami melaporkan seorang anak laki-laki berusia 22 bulan dengan diagnosis hipospadia penoskrotal yang sebelumnya telah menjalani kordektomi pada usia 20 bulan. Pasien mendapatkan injeksi testosteron intramuskular (Sustanon™) dengan dosis 25 mg setiap bulan selama empat bulan. Pasien kemudian dijadwalkan untuk operasi rekonstruksi tahap kedua dalam waktu tiga bulan, dan kembali diberikan terapi testosteron dengan dosis 25 mg setiap tiga minggu selama tiga bulan berikutnya. Setelah regimen terapi ini, lingkar penis (penile circumference/PC), panjang penis flaksid (flaccid penile length/FPL), dan panjang penis teregang (stretched penile length/SPL) meningkat dari 2,5 cm; 2,5 cm; dan 3,0 cm menjadi 3,0 cm; 3,2 cm; dan 4,0 cm. Kesimpulan: Tindakan koreksi hipospadia tetap memiliki risiko komplikasi anatomis maupun fungsional. Pemberian testosteron praoperatif dapat menjadi strategi yang bermanfaat untuk mengoptimalkan hasil operasi melalui peningkatan vaskularisasi, ukuran glans, serta panjang penis, sehingga berpotensi menurunkan angka komplikasi pascaoperasi. Keterbatasan utama laporan kasus ini adalah tidak lengkapnya data tindak lanjut pascaoperasi.

Review

This case report provides a timely and relevant exploration into the potential utility of preoperative testosterone administration in optimizing outcomes for hypospadias repair. The authors present a concise narrative around a pertinent clinical question: whether adjunctive testosterone therapy can indeed improve the anatomical and functional results of surgery for this common congenital anomaly. The abstract clearly outlines the rationale, citing proposed benefits such as enhanced penile vascularization, increased glans diameter, and augmented penile length, all of which are hypothesized to mitigate postoperative complications. A strength of this report lies in its clear presentation of the clinical scenario. The detailed regimen for testosterone administration (Sustanon™, 25 mg monthly for four months, followed by 25 mg every three weeks for another three months) is commendable, offering valuable specifics for potential future studies. Furthermore, the quantifiable improvements in penile dimensions—specifically the increases in penile circumference, flaccid penile length, and stretched penile length—provide concrete evidence of the drug's intended endocrine effect within the single reported case. This objective data supports the immediate physiological impact of the therapy on penile growth, which is a desirable attribute for complex reconstructive surgery. Despite these strengths, the report’s primary limitation, as acknowledged by the authors, is the incomplete availability of postoperative follow-up data. While the observed penile growth is encouraging, the ultimate goal of preoperative testosterone is to improve *surgical outcomes* by reducing complications, which cannot be definitively assessed without comprehensive postoperative information. As a single case report, generalizability is inherently limited, precluding any definitive conclusions on the widespread efficacy or safety of this therapeutic strategy. Future research would benefit from larger cohort studies, ideally randomized controlled trials, that include objective measures of surgical success and long-term follow-up to evaluate functional and cosmetic outcomes, as well as potential adverse effects, thereby providing a more robust evidence base for this promising adjunctive treatment.

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