الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Hypospadias is one of the most common congenital anomalies, occurring in approximately 1 in 250 newborns .Hypospadias is a wide spectrum of abnormalities involving the inferior surface of the penis and having in common a urethral opening that lies on the inferior surface of the penis.
The penis grows less than 0.8 cm in the first 3 years of life: the phallus that is small at 3 months of age will still be small at 3 years of age.
Repair of the microphallic hypospadiac penis can be technically challenging. The use of preoperative androgen therapy to enhance penile size before genital reconstruction has been proposed to improve the cosmetic and surgical results of these demanding operations. Whether preoperative endocrine therapy is really beneficial is controversial.
Although some studies have favored hormonal administration before hypospadias repair , others concluded that preoperative testosterone actually had a higher risk of complications.
Randomized trials have found no significant difference in outcome with topical or intramuscular routes of administration.
One study concluded that there was a disproportional growth response to androgens between the proximal and distal penile shaft and the current study found almost same results, which means significant distal migration of the meatus.
Till now no consensus about the protocol to use hormonal stimulation regarding hormone therapy of choice, appropriate dose, frequency, concentration, route of application.
In this study, we found significant increase in all measurements of the phallus by using topical testosterone 1% once daily for 30-40 days, and concluded no significant difference in the results between the 2 group apart from edema which is more in treated group and skin shape which is better in the treated group.
Moreover we didn`t faced with significant healing complications or local complications like skin pigmentation or irritation following hormonal stimulation.
One randomized study evaluated the histological effects of topical testosterone on vascularization, reaching the conclusion that this use promotes an increase in both the number and volume density of blood vessels after using 1 % testosterone topically before hypospadias surgery.
As regards the assessment of the microvessel density using CD31
immunostaining ,we could not figure out significant difference between testosterone treated hypospadiac group and those untreated hyopspadiac group and both groups showed mild to moderate increase in microvessel density which was unsatisfactory.
Histopathological differences were not also significant except for ERβ which was strongly expressed in the treated group compared to moderate expression in the control group, which may aid in identification of the aetiology of hypospadias, but not affecting the healing process.
Difficulty encountered was regarding the small number of patients included in our study and short term follow up, also we couldn`t compare different protocols for hormonal stimulation because results would have been biased .
By the way, post-operative parents` satisfaction in both groups was not significantly different.
Recommendations
No need to subject the child to hormonal stimulation except if you have a very small glans.
Future studies:
1- Based on the disproportional growth of the ventral side of the shaft proximal and distal to the meatus, future studies should try to confirm the difference in androgen receptors expression between proximal and distal portion of the phallic shaft, because now, it`s questionable, whether to remove or keep the urethral plate in proximal hypospadias cases as patient may develop chordee in the future.
2- Try to carry out the same study on larger number of patients, on longer period, or even a multicenter study.
3- Compare different protocols for hormonal stimulation.
4- Long term follow up of these patients to evaluate the effect of hormonal stimulation on bone maturation.
5- To document the measurements just after finishing the hormone and before starting the surgery.
6- To measure the serum testosterone level in the next studies.