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.
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SKT and RA were involved in the conceptualization, assessing the quality of studies, and writing the manuscript. SKT and AA participated in searching the databases, assessing the quality of studies, conducting meta-analysis, and preparing figures and tables. AG, PKS, RC, and RB were involved in writing the manuscript, providing supervision, and critically revising it for important intellectual content. They have all approved the current version sent for publication.
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Thanneeru, S.K., Gupta, A., Chanchlani, R. et al. Preoperative topical estrogen application in the management of hypospadias: a systematic review. Pediatr Surg Int 40, 132 (2024). https://doi.org/10.1007/s00383-024-05708-x
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DOI: https://doi.org/10.1007/s00383-024-05708-x