Topical oestradiol thickens foreskin epidermis in boys undergoing hypospadias surgery

Preoperative topical oestradiol increases epidermal thickness and dermal collagen in the foreskin in children with hypospadias, a recent study has found.

Thirty-three boys were randomly assigned to receive topical testosterone (n=13; mean age, 3.15±2.64 years), oestradiol (n=10; mean age, 3.8±2.97 years) or neutral base (placebo; n=10; mean age, 5.10±3.17 years) ointments. Foreskin fragments were then excised, fixed and sectioned for histological examination. A Zeiss camera and computer image capture system was used to measure epidermal thickness.

After treatment, boys in the oestradiol group showed superior mean epidermal thickness relative to those in the testosterone and placebo groups (33.67±5.53 vs 20.84±7.34 and 18.99±4.54 µm; p<0.0001 for both comparisons). Testosterone, on the other hand, was not significantly different from the control ointment (p=0.4760).

There were also notable changes in collagen fibres, determined through quantitative morphometric analysis under polarized light. Mean expression of type 1 collagen, for example, was significantly elevated in the oestradiol vs testosterone and control group (155.6±34.85 vs 125.8±27.72 and 132.2±19.81 pixels; p=0.032).

Expression of type 3 collagen, however, remained comparable across the different treatment groups (77.39±15.61 vs 67.18±18.08 and 66.17±17.12 pixels; p=0.2709).

“Previous good results in skin of other sites combined with our recent finding of epidermis thickness and dermal collagen improvement could prompt a potential benefit of using oestradiol before hypospadias surgery,” said researchers, noting, however, that these studies first need to be replicated.

Future efforts should also seek to further qualify how the histological effects of topical oestradiol translate to clinical outcomes, they added.