Comparison of Microvessel Density and Growth Factor Levels Between Inner and Outer Prepuce in Distal Hypospadias.

Objective: Preputial flaps are frequently used in hypospadias repair, but the healing potential of preputial tissue remains a concern. This study aimed to evaluate the microvessel density (MVD) and growth factor receptor levels (VEGFR and TGF-!R) in the prepuce of patients with hypospadias compared to controls and to compare these parameters between the inner and outer preputial layers to determine their relative suitability for hypospadias repair. Methods: The study included children under 14 years of age undergoing primary distal hypospadias surgery as cases and individuals undergoing elective circumcision as controls. Specimens from the inner and outer prepuce were collected, and immunohistochemical staining was performed using CD31 antibodies to assess MVD and VEGFR and TGF-!R antibodies to evaluate growth factor levels. The staining intensity was semi- quantitatively analyzed using a histological scoring system. Results: Microvessel density was significantly higher in the inner prepuce than the outer prepuce in both cases and controls (P < .05), suggesting a potential advantage of inner prepuce tissue in hypospadias repair. Conversely, VEGFR levels were significantly higher in the outer prepuce in cases (P < .05), indicating different healing potentials between these layers. Transforming growth factor ! receptor levels were significantly lower in both the inner and outer prepuce of controls compared to cases (P < .05). Other findings did not reach statistical significance. Conclusion: The higher MVD in the inner prepuce suggests it may be preferable for hypospadias repair. However, the differential VEGFR levels between the inner and outer prepuce highlight complex healing dynamics, emphasizing the need for further research to draw definitive conclusions.