Rise in prevalence of hypospadias

Abstract

Editorial Comment: Paulozzi et al report a 2-fold increase in the prevalence rates of hypospadias in the United States from 1970 to 1993 from the Metropolitan Atlanta Congenital Defects Program (1968 to 1993) and the United States Birth Defects Monitoring Program (1970 to 1993). During this period the incidence of all types of hypospadias increased from 20.2 to 39.7/10,000 births (0.20 to 0.4040). The incidence of severe (penile, scrotal and perineal) hypospadias increased from 1.1 to between 2.7 and 5.5/10,000 births. The increase occurred at a rate of 1.4% per year among white and 5.7% per year among nonwhite patients. Similar increases have been reported from England and Wales,' Sweden,2 Denmark3 and Hungary. That more severe forms of hypospadias appear to be increasing more rapidly than minor forms refutes the argument that has been made that this apparent increase could represent increased reporting of minor cases of hypospadias. Hypospadias has been linked to increased maternal age at menarche, menstrual cycle irregularities, exogenous hormone use and, recently, exposure to pollutant^.^ Dolk argues that this apparent worldwide increase in hypospadias may be considered with other reports of decreasing sperm counts, and increases in prevalence of cryptorchidism, testicular cancer and breast cancer in women. If this association is valid, it may underscore the importance of the future study of the etiology of hypospadias and the effect of industrial pollutants. Douglas A. Canning, M.D. 1. Matlai, P. and B e d , V.: Trends in congenital malformations of external genitalia. Lancet, 1: 108, 1985. 2. W e n , B. and Winberg, J.: An epidemiological study of hypospadias in Sweden. Acta Paed. Scand.,