Low-dose Human Chorionic Gonadotropin Stimulation Test as a Prognostic Incontinent Indicator in Boys With Bladder Exstrophy-epispadias Complex.

OBJECTIVE: To investigate the effect of low-dose human chorionic gonadotropin (HCG) administration on structural changes in the lower urinary tract in boys with urinary incontinence in the setting of bladder exstrophy-epispadias complex (BEEC). PATIENTS AND METHODS: We prospectively evaluated 30 patients (median age 7.5 years) with BEEC and randomly divided them into 2 groups. Patients in the HCG group were administered 250 IU HCG intramuscularly 3 times per week during a 4-week period. The other 15 patients served as the control group. The patients were followed up for a mean duration of 4 years. Incontinence rate, hormonal changes, penile length, prostate size, and bladder capacity were evaluated using 3D sonography or pelvic magnetic resonance imaging and uroflowmetry studies before and after HCG administration. RESULTS: The incontinence score improvement was significantly higher in the HCG group (P = .01). A significant increase was detected in the health-related quality of life score of both patients and parents at the final follow-up (P < .001). The total prostate size (P < .0001) and bladder capacity (P < .0001) increased significantly in all patients of the HCG group. Basal serum testosterone level increased significantly after the first (P = .001) and last (P < .001) injections with no significant increase 3 months after the last injection (P > .05). No major side effect was found following the administration of HCG, with no need for open surgical bladder neck reconstruction. CONCLUSION: Our preliminary results suggest the role of low-dose HCG in boys with BEEC suffering from urinary incontinence. The data also reveal the role of prostate enlargement in the improvement of urinary incontinence. Chronic treatment with HCG increases bladder capacity that may facilitate future reconstructive surgery.

[Plasma testosterone values in patients with somatosexual development disturbances from 11 years old to adulthood]. / Plasma-Testosteronwerte bei Patienten mit somatosexuellen Entwicklungsstörungen im Alter von 11 Jahren bis in das Erwachsenenalter

The testosterone plasma level was determined in 5 groups: 1. in 69 normal juveniles and 85 fertile males at the age of 11 to 45 years, 2. in 42 patients with hypospadia or epispadia aged 11 to 25 years, 3. in 72 males with unilateral cryptorchidism at the age of 11 to 45 years, 4. in 83 males with bilateral cryptorchidism aged 11 to 45 years and 5. in 106 patients with Klinefelter's syndrome at the age of 16 to 45 years. A pubertal increase of the testosterone plasma level was found to begin in subjects with cryptorchidism or Klinefelter's syndrome at a similar age as in the control group. However, as early as at the age of 13 to 14 years decreased testosterone values were found in the patients as compared to normal juveniles. Between 19 and 20 years, the plasma testosterone level was significantly decreased in all patient-groups as compared to the controls of similar age. In adulthood, plasma testosterone concentrations in the patient groups were observed to be 4 to 6 ng/ml without significant age-dependent changes, which are characteristic of normospermic males. Different degrees of clinical symptoms indicating androgen deficiency found in various patient groups despite similar androgen levels in adulthood suggest a different responsiveness of their target organs to androgens.

Plasma testosterone values in hypopspadiacs.

The plasma testosterone values were determined by radioimmunoassay in a group of 42 patients with a severe form of hypospaida, in one case of epispadia, in a control group of 69 boys with an adequate development of sex organs, and in 48 well fertile men. It was found that the beginning of pubescence started in both groups at the same age but that already from 13 years onwards the level of male sex hormone in the blood was lower in hypospadiacs than in the individuals of the control group. The difference is statistically significant in the subgroups from 19 years of age onwards. It is assumed that the function of gonads was insufficient in these patients not only in the period of intrauterine life, but that it often remains reduced even in puberty and adulthood.