Androstanolone treatment for congenital penile curvature.
OBJECTIVES: To test the etiological hypotheses of congenital penile curvature (CPC) and to infer the possible therapeutic approaches. MATERIALS AND METHODS: Seventy patients affected by CPC were enlisted for the present study: 37 with left curvature, 21 with ventral curvature, 11 with left ventral-lateral curvature, and 1 with right curvature. All patients under the age of 21 years were encouraged to take local medical therapy with alcohol androstanolone gel in a dosage of 0.15 mg/cm(2) of surface area. Group A (17-43 years of age) consisted of patients who refused medical therapy and decided to solve their problem with surgery. They underwent Nesbit's operation and were given a contralateral biopsy of the tunica albuginea at the same time. Cytoplasmic androgen receptors (CARs) were quantified in the tunica albuginea of both cavernous bodies (CBs). Group B consisted of 26 patients aged between 4 and 21 years who were given local medical therapy with androstanolone in alcohol gel. They underwent a maximum of 3 therapy cycles each lasting 2 months with a 1-month suspension between each. Group C consisted of 9 patients (27-53 years of age) who were fathers of 9 group B patients. These adults were also affected by penile curvature and taken into consideration as a control group because we have observed three spontaneous corrections of penile curvature in puberty. RESULTS: CARs research in group A and in 6 group B patients under the age of 20 revealed a 2-5 times reduction on the concave part of the cavernous body compared to the contralateral one. This difference progressively decreased in older patients. In group B, 14 patients aged between 4 and 15 years and 1 aged 17 (53.8%) were treated with a local androstanolone therapy and the result was a regression in the curvature between 30 and 100%. Another 9 patients aged between 17 and 21 years did not show any improvement despite androstanolone treatment. CONCLUSIONS: The results show a 2-5 times reduction in CARs on the hypoplastic cavernous body of young male patients. These differences progressively decreased in older patients. The positive results of the androstanolone therapy in patients under the age of 15 and the negative ones in older patients are certainly related to the quantity of CARs present on the tunica albuginea.