Pattern of penile growth after HCG treatment in sever hypospadias might provide a clue to intra-natal endocrinopathy and pathogenesis

Abstract EN

Hypospadias is a relatively common congenital anomaly of the penis that arises in 2 to 8 of 1000 live births, often as an isolated anomaly.

This anomaly is repaired surgically in the first year of life to improve the cosmetic appearance and establish a glandular position of the urinary meatus for voiding and deposition of semen later in life.

The aim of this study is to evaluate the effectiveness of HCG hormonal manipulation in inducing penile growth in hypospadias boys before surgical repair, and the pattern of this growth and response, in addition to that this thesis try to add more knowledge to the etiology and pathogenesis of one of these relatively common urogenital disorder.

Patients and methods :- this small series thesis included 16 boys with an age ranged from 3-48 ms who had proximal and pen scrotal hypospadias with sever cordea .All boys received a full course of HCG treatment using the standard WHO protocol of HCG therapy in pediatric age group.

The degree and rate of response to HCG therapy together with the pattern of penile growth have been measured and evaluated before and one week after HCG therapy using the student T– test for statistical analysis. Results :- at the end of HCG treatment penile growth has been achieved in all boys. The cordee decreased and penile length increased in all cases.

The mean stretched penile length was changed from 18.68 pre HCG to 31.97 post treatment (P value > 0.001).

The average penile length was nearly doubled after HCG treatment with an increase of 40 % to 180 % (mean 83 %, P value < 0.001).

What was very interesting and major finding that emerge during this study, is that the penile response and growth to HCG treatment was not universal over the whole shaft of the penis, with by far most of increment in penile length occurred proximal to urethral meatus and the percentage of penile growth was 262 % (P value < 0.001) proximal to meatus, while it was only 24 % not significant (P value > 0.001) distal to it.

This disproportional penile growth causing the meatus to advance distally in all cases with a mean distal migration of urethral meatus was 9.75 mm (P value < 0.001). Conclusion :- HCG treatment in hypospadias was very effective in achieving sufficient penile growth that might facilitate the surgical outcome, the other finding is that hypospadias even the sever one is not at a fixed stage or degree, but it can easily be manipulated by hormonal treatment in addition to that, this study suggest that post natal response of hyposadias penis to HCG might provide a mirror that reflect its intra natal response during organogenesis and embryogenesis, and this thesis might provide a different insight toward the pathogenesis of hypospadias-chordea complex by diverting more attention and focusing toward a localized endocrinopathy that affect the tissue responsiveness to androgen.