The Use Of Human Chorionic Gonadotropin For Penile Reconstruction In Bladder Exstrophy And Total Epispadias Patients

Main Category: Urology / Nephrology
Also Included In: Men's health
Article Date: 30 Apr 2007 - 0:00 PDT

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UroToday.com- Makedonsky investigated the effect of intramuscular human chorionic gonadotropin administration on penile enlargement before genital surgery as well as its influence on penile skin histology and testicular descent. The study examined 45 boys with a median age of 8 months and a range of 3-28 months with total epispadias as classic bladder exstrophy combined with cryptorchidism. Thirty patients were administered 250-500 international units of HCG intramuscularly 2 times per week for 3 weeks before reconstructive surgery. Skin biopsies were obtained for human epidermal growth factor and human epidermal growth factor reception determination. Skin specimens of the prepuce of 18 circumcised patients were used as controls. Post treatment testicular position was also evaluated.

The group found that human chorionic gonadotropin caused a mean increase in penile length of 1.8 cm and in circumference of 1.2 cm as well as improved local vascularity in all patients. Compared to the controls, the penile skin of exstrophy/epispadias patients showed a significant decrease in the average amount per field of epidermal growth factor and its receptors by 10%. The potential side effects of human chorionic gonadotropin treatment were monitored 3-6 months postoperatively. Basal testosterone and LH levels were obtained in patients before and during therapy as well as postoperatively. Testicular descent was achieved in 21 patients (70%) and no significant side effects or complications were encountered in any of these patients.

The study concluded that mean epidermal growth factor and its receptor values are decreased in the penile skin of exstrophy/epispadias patients. The use of preoperative human chorionic gonadotropin administration leads to an increase in epidermal growth factor and its receptor values and significantly contributes to successful reconstruction in these patients, especially in cases with a paucity of penile skin or inpatients who have undergone previous repairs. Temporary penile stimulation by human chorionic gonadotropin in patients with bladder exstrophy combines with cryptorchidism allows the penile operation to be carried out earlier and contributes to testicular descent while demonstrating negligible side effects.

I.A. Makedonsky

European Journal of Pediatric Surgery 16: 428-431, 2006
Reviewed by UroToday.com Contributing Editor Pasquale Casale, MD

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