S. F. Rosati1, D. Parrish1, J. Haynes2, K. Brown3, M. Poppe3, D. Lanning2 2Virginia Commonwealth University,Division Of Pediatric Surgery,Richmond, VA, USA 3Virginia Commonwealth University,School Of Medicine,Richmond, VA, USA 1Virginia Commonwealth University,Department Of General Surgery,Richmond, VA, USA
Introduction:
Precocious puberty is defined as the onset of secondary sexual characteristics before the age of 8 in girls and the age of 9 in boys and is associated with an increase in linear growth velocity, acceleration of bone maturation, and can result in early epiphyseal closure if untreated. The most common cause of precocious puberty is idiopathic central precocious puberty (CPP), traditionally treated with monthly injections of depot parenteral preparations of gonadotropin-releasing hormone agonists (GnRHa). An alternative treatment is a subcutaneous implant that contains histrelin acetate, which is continuously released over one year; it is then removed or replaced with a new implant. The aim of this study was to conduct a retrospective review of one surgeon’s experience with the histrelin implant and to examine patient satisfaction in follow-up.
Methods:
After obtaining IRB approval, we conducted a retrospective review of one surgeon’s patients with CPP treated with the histrelin implant. Additionally, parents were contacted by telephone to gather satisfaction with respect to post-operative pain, cosmesis, preference to depot injections, and effectiveness.
Results:
Fifty-eight children, average age 8.4 years old (range 7-14) underwent at least one histrelin implant insertion for treatment of CPP. Telephone follow was achieved in 44. All 44 children received local analgesia at implantation; 32 also received conscious sedation. Thirty-nine children (89%) had at least one implant replacement. Eight children (18%) received injections before undergoing implant insertion; the majority of the parents (88%) preferred the implant. On average, parents’ satisfaction with the insertion of the implant rated 9.5 on a scale of 1-10 with 10 being most satisfied; parents’ satisfaction with replacement of the implant was also rated highly at 9.5. The patients’ discomfort after initial surgical insertion was rated on average 3.9 with 10 being the most discomfort (range 1-6); discomfort after replacement and removal was even lower at 2.3 and 2.7, respectively. Almost all of the parents (95%) stated that they would agree to have their child undergo surgical implantation again, and the majority of children (93%) returned to baseline function within 24 hours. Parents rated the cosmetic appearance of the scar after surgery on average at 9.1. There were no surgical complications with the placement, replacement, or removal of the implant.
Conclusion:
This study suggests that the using a histrelin subcutaneous implant for control of CPP provides a safe and effective method that, according to parents, is associated with minimal discomfort, allows for a quick return to normal function and activity, and is a preferred method of treating CPP when compared to depot injections in our limited subset analysis.