Preoperative topical estrogen application in the management of hypospadias: a systematic review
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In brief
In brief
This systematic review of 4 RCTs (387 patients) evaluates topical estrogen as preoperative therapy for hypospadias repair. Current evidence shows no significant improvement in penile dimensions or reduction in postoperative complications compared to standard care, though study heterogeneity limits definitive conclusions.
- Topical estrogen shows no significant improvement in penile dimensions or reduction in post-urethroplasty complications for hypospadias.
- Four RCTs (387 patients total) used varying estrogen formulations and timing, limiting direct comparison of outcomes.
- Current evidence does not support topical estrogen as superior to conventional testosterone therapy for preoperative hypospadias management.
- Study heterogeneity in formulation, timing, and hypospadias severity requires cautious interpretation of pooled results.
- Further animal and human studies needed to clarify potential wound-healing benefits of estrogen in hypospadias repair.
Written by the GCMD Library team from the article.
Abstract
Local estrogen therapy has been explored as an alternative to conventional testosterone therapy in children requiring urethroplasty for hypospadias. Our objective is to evaluate if preoperative estrogen stimulation reduces post-urethroplasty complications and enhances penile dimensions. A systematic search was conducted on various databases, selecting only randomized controlled trials (RCTs) that tested estrogen on hypospadias patients under 18 years. Articles underwent sorting following PRISMA guidelines and bias risk was assessed using the JBI clinical appraisal tool for RCTs. Out of 607 screened records, 10 underwent full-text review, and 4 randomized controlled trials (RCTs) were selected for analysis. The total patient cohort across studies was 387 with 174 in the estrogen group. All studies utilized topical estrogen, but in different formulations and timings. Prudence is necessary for interpreting results due to variations in formulation, timing, and hypospadias type across studies. Limited by a small number of studies and outcome presentation non-uniformity, the review suggests no change in penile dimensions or postoperative complications with topical estrogen. Further research is needed to explore wound-healing properties of estrogen in hypospadias through animal and human studies.
Registration and protocol: Registered in Prospero CRD42024502183.