Hypospadias/Penile Surgery Structural Study of Prepuce in Hypospadias—Does Topical Treatment With Testosterone Produce Alterations in Prepuce Vascularization? André Netto Bastos, Leonardo Resende Souza Oliveira, Carlos Eduardo Prata Fernandes Ferrarez, André Avarese de Figueiredo, Luciano Alves Favorito and Jose Murillo Bastos Netto* From the Federal University of Juiz de Fora and Urogenital Research Unit, Rio de Janeiro State University, Rio de Janeiro, Brazil Abbreviation and Acronym vWF = von Willebrand’s factor Study received institutional review committee and parental approval. * Correspondence: Av. Rio Branco, 2985/sl. 605, Juiz de Fora-MG, Brazil, 36010012 (tele- phone: 55(32) 3218-9899; FAX: 55(32)3218-9899; e-mail: jmbnetto@uropedjf.com.br). Purpose: Androgen stimulation before hypospadias surgery has resulted in in- creased penile size, fewer complications and improved cosmesis, and suggests increased neovascularization. To our knowledge the real effect on neovascular- ization remains to be proved. We studied the histological effects of testosterone on neovascularization. Materials and Methods: A total of 26 boys with hypospadias were randomly allocated to 2 groups before surgical correction. Group 1 did not receive any treatment and group 2 received 1% testosterone propionate ointment twice daily for 30 days before surgery. During the surgical procedure a fragment of prepuce was excised and prepared for histological evaluation. The number and volume density of blood vessels were determined by labeling for von Willebrand’s factor. Blood vessel quantification as volume density was done using a video microscopy system with a superimposed cycloid arch test system. Results: The groups were similar in age and hypospadias classification. Testos- terone treated prepuces (group 2) had an increased absolute number of blood vessels (mean  SD 8.5  1.3 vs 4.8  1.8 vessels per field) and increased blood vessel volume density (mean 50.5%  7.8% vs 24.8%  8.6% vessels per point) (each p 0.001) compared to those in untreated patients (group 1). Conclusions: The use of 1% testosterone propionate ointment before hypospadias surgery produces neovascularization in absolute numbers and in volume density. Key Words: urethra; neovascularization, physiologic; hypospadias; testosterone; foreskin HYPOSPADIAS is a common congenital defect and surgical correction, even in experienced hands, is prone to compli- cations. A cosmetically adequate surgi- cal outcome is often not attained with 25% of patients reporting dissatisfaction with the cosmetic appearance of the pe- nis. 1 Androgen stimulation with tes- tosterone, dihydrotestosterone or hu- man chorionic gonadotropin has been used to improve the cosmesis and de- crease the complications of hypospa- dias surgery since it temporarily in- creases the penis and makes surgical correction easier. 2 Besides a penile in- crease other studies have shown de- creased chordee, corpus spongiosum thickening and decreased hypospadias. 3 Chalapathi et al found no differences in penile size, testosterone side effects and serum testosterone when comparing top- ical to intramuscular testosterone. 4 Nevertheless, the testosterone ef- fects that lead to better postoperative 2474 www.jurology.com 0022-5347/11/1856-2474/0 Vol. 185, 2474-2478, June 2011 THE JOURNAL OF UROLOGY ® Printed in U.S.A. © 2011 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH,INC. DOI:10.1016/j.juro.2011.01.035