The assessment of hypospadias

Hypospadias is a congenital anomaly involving the anterior urethra that can atTect both men and women. The dcfonnity is characterised by a dystopia of the extemal ori1ice of the urethra and can be associated with a curvahu'c of the penile body in male subjects. The incidence of hypospadias in men is estimated as one in two to three hundred live male bilths and seems to be increasing although it varies according to the registration system used, geographical area and racial influences I. The precise aetiology of this anomaly remains unclear, although certain risk factors can be assessed. For instance, hypospadias is known to cluster in families but little else is definitive about the genetics involved in its aetiology and it still seems to be a multifactorial anomaly 2-6. Early exposure to progestins in utero during organogenesis also appears to be of influence in the development of hypospadias with a twofold relative risk 7. Because of the sporadicness of this exposure and hypospadias it is, however, difficult to demonstrate a definitive association J. Another factor held responsible as a possible cause of hypospadias is a local vascular insufiiciency of the embryo during pregnancy~. The morphogenesis of the male external genital system and therefore the hypospadias def01l11ity as well, have been the subject of controversy in the past 9-11. Glenister, a lecturer at the Charing Cross Hospital Medical School in London, contributed a substantial amount of knowledge on thc development of the male external genital 9.12.13. His general concept of the cmbryogenesis of the male anterior urethra has had velY little opponents in the literature. Some details, such as the fonnation of the glandular part of the urethra or the onset of preputial dcvelopment, are challenged by others 14-18. Searching for cellbiological mechanisms like cell proliferation and apoptosis, responsible for normal development of the male genital system, it is striking to find nothing on this subject in the literahlre

Urodynamic evaluation of hypospadias repair

Purpose: We performed a cross-sectional evaluation of voiding in a population undergoing hypospadias repair to determine whether patients had urinary obstruction at various intervals of followup after the last operation. Materials and Methods: Of approximately 600 patients undergoing hypospadias repair at our department during a 30-year interval 175, 40 months to 66 years old were evaluated. Therefore, we created a cross-sectional study group for evaluation of voiding function. All patients had undergone the final operation for hypospadias at least 1 year previously and were toilet trained. Severity of the initial hypospadias was scored together with the operative technique. Parameters evaluated were medical history, physical examination and uroflowmetry using a rotating disk. Uroflowmetry data (maximum flow rate and voided volume) were plotted in age-related nomograms in 4 different age groups: less than 8 (28 patients), 9 to 14 (18), 15 to 21 (39) and more than 21 (91) years old. All flow charts were evaluated by 2 of us (J. F. A. v. d. W. and E. B.). Results: The severity of initial disease was grade 1 in 30% of the patients, grade 2 in 57%, grade 3 in 10%, grade 4 in 2% and unknown in 2%. The operative technique performed was a van der Meulen repair in 113 patients (65%), a combined Byars-Denis Browne repair in 56 (32%) and miscellaneous in 6 (3%). According to the uroflowmetry nomograms there was a tendency for an increased number of patients to have a normal maximum flow rate with increasing age. A total of 14 patients had a flow curve that suggested distal urethra obstruction and none was symptomatic. There was no difference in uroflowmetry characteristics regarding the operative technique. Conclusions: No difference in uroflowmetry could be established among the operations. There seemed to be a tendency towards improvement in uroflowmetry with increasing followup. There was no direct relationship between low maximum flow rates and clinical apparent obstruction