Relation between outcome of primary hypospadias tubularized incised plate repair and penile growth factors expression

Abstract Objective To study the relation between penile growth factors expression (Epidermal growth factor (EGF) & receptor (EGFR) and Transforming growth factor β1 (TGF β1) & Microvessel densities and outcome of primary hypospadias Tubularized incised plate (TIP) repair. Material and methods Group 1 consists of 31 patients with primary hypospadias (distal & midpenile) with mildy (< 8 mm) and moderately (8–10 mm) grooved urethral plate who was fit for TIP repair. Group 2 consists of 23 kids came for routine circumcision as control group. Specimens were collected from prepuce of both groups and parameatal skin in group 1 only. Specimens were tested for expression of TGF β1, EGF, EGFR and microvessel density. Every patient in group 1 was followed for 6 months for presence of urethrocutaneous fistula (UCF), meatal stenosis, wound dehiscence, penile torsion, residual chordee and urethral stricture. Results The overall complications of hypospadias repair were 29%. The most common complication was UCF (25.8%) with overall reoperation rate of 29%. Preputial expression of EGF and cluster of differentiation 34 (CD34) density were statistically higher in control group compared to hypospadias group ( p value 0.0001). Parameatal skin expression of EGFR & TGF and CD34 density were statistically higher than preputial expression in hypospadias group. The inner prepuce has increased CD34 density compared to outer prepuce in both hypospadias and control groups ( p value 0.0001). Down regulation of growth factor expression at parameatal urethral plate is independently associated with higher rate of complications ( p value 0.0001). Conclusions The technique of assessing penile skin growth factor expression is useful to identify the healing quality of epithelial tissues. Down regulation of growth factor expression at parameatal urethral plate is independently associated with higher rate of complications. The regulation of those studied factors doesn’t preclude the essential and cardinal impact of surgical skills in tissue healing and reconstructive tricks. Finally, prospective studies should be planned searching for methods to accelerate the role of the studied factors using biological modifiers.