Consultation with the specialist: hypospadias.

Abstract

1. Warren T. Snodgrass, MD* 1. *Department of Urology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX After completing this article, readers should be able to: 1. Describe the incidence and cause of hypospadias. 2. Determine when evaluation for intersexuality should be considered in a child who has hypospadias. 3. Delineate when boys who have hypospadias should undergo surgical correction. A term baby is found on initial newborn examination to have penoscrotal hypospadias. The family is distressed and asks several questions: 1. Does he have any other problems, and is this an intersex condition? 2. Does he need other tests? 3. Can he urinate the way he is? 4. Why did this happen, and since we never heard of it before, how common is it? 5. Can it be fixed, and if so, when? Who should do the surgery? 6. We planned to have you circumcise him; can you still do that? Hypospadias refers to incomplete urethral development that results in a meatus located anywhere from the proximal glans to the perineum. The condition occurs in approximately 1 in 150 to 1 in 300 males, making hypospadias the second most common birth defect in boys after cryptorchidism. Recent surveys suggest that the incidence of hypospadias is increasing in industrialized countries, possibly due to environmental estrogens or antiandrogens. The external genitalia are initially indifferent and, in the absence of androgen, inherently develop the female phenotype. The critical timeframe for phallic development is from 8 to 12 weeks’ gestation, when the genital tubercle elongates and the urethral plate on its ventral surface tubularizes from proximally to the tip of the glans. During this phase, the penis is curved ventrally because the corpora cavernosa, as well as shaft skin and prepuce, develop faster on the dorsal than the ventral aspect. After 12 weeks’ gestation, androgen stimulation increases the size of the phallus. Hypospadias results from an arrest in these normal processes. The incompletely tubularized urethra opens on the undersurface, …