Effect of Massage with Topical Corticosteroids on Recurrent Curvature in Staged Repair of Proximal Hypospadias: A Retrospective Study

Objectives: Ventral penile curvature often accompanies severe hypospadias and poses a risk of recurrence after repair. We postulated that altered myofibroblastic activity at the repair site contributes to recurrent curvature. To address this mechanism, we adopted a specific clinical strategy in 2017. We instructed patients to apply upward massage to the ventral side of the penis using a topical corticosteroid ointment between the two stages of Bracka repair. The aim of this study was to assess the impact of this intervention on the recurrence of curvature after surgery.
Methods: A retrospective review of the medical records of all patients who underwent Bracka repair for hypospadias between January 2009 and May 2023 by a single senior surgeon was conducted. Patients were divided into two groups according to whether they received steroid treatment, and complication rates were compared. In the steroid group, parents applied Betnovate® 0.1% (betamethasone valerate) ointment twice daily with upward massage to the ventral penile surface, beginning in the second post-operative week after Bracka stage 1 surgery and continuing for three months. The primary outcome was recurrence of curvature during the second stage and at long-term follow-up, while secondary outcomes included dehiscence and fistula formation.
Results: The review included 60 patients (median age: 14 months [5–171]) who underwent Bracka repair for hypospadias, with 40 in the steroid group and 20 in the control group. The mean degrees of curvature at presentation were similar (91 and 89 degrees, respectively; p>0.05). Compared with the control group, the steroid group had a significantly smaller mean degree of curvature both at the second-stage operation (17 vs. 26 degrees, p=0.04) and during long-term follow-up (15 vs. 25 degrees, p=0.03). There were no steroid-related complications, and no significant differences in the incidences of dehiscence and fistula formation were observed between the groups (p>0.05).
Conclusion: Our findings suggest that the application of a topical corticosteroid ointment with upward massage to the ventral graft site between stages 1 and 2 of Bracka hypospadias repair may reduce the recurrence of curvature both during the second stage of repair and at long-term follow-up.

Keywords: Betamethasone valerate, chordee, hypospadias, massage, penis/abnormalities, recurrence, urethroplasty