Urethral Opening Research Articles

Vestibulovaginal leiomyosarcoma in a mare

SummaryA 14‐year‐old Quarter Horse mare presented for a mass within the vestibule and vagina resulting in external compression and incomplete occlusion at the external urethral opening with subsequent difficulty urinating. Examination revealed an approximately 15 × 10 cm lobulated mass within the vestibule and caudal vagina attached via a broad base dorsally. Histopathology of the mass identified a low‐grade leiomyosarcoma. Complete resection was not possible, and surgical debulking of the mass was performed during standing sedation using a vessel‐sealing and dividing device. The mare was discharged 3 days post‐operatively without any complications. Recheck examinations performed at 1 month and 8 months’ post‐surgery revealed excellent healing of the surgical site and no apparent tumour regrowth.

EP12.13: A case of partial urorectal septum malformation sequence with a very small lower abdominal cyst and review of literature

Background: Partial urorectal septum malformation sequence is a rare congenital malformation of urorectal septum dysplasia and failure of the breakdown of th cloacal membrane, is characterised by abnormalities of the ambiguous genitalia, urogenital organs, a single perineal/anal opening that drains a common Cloaca, and absent anus. We report a case of partial urorectal septum malformation sequence, who was suspected on pregnancy ultrasound scan at 24+6 weeks' gestation in our department and confirmed upon delivery. Case presentation: A 19-year-old married woman, Gravida 1 Para 0, presented to antenatal clinic of Cheng Du Women and Children's Central Hospital, Si Chuan province, China, at 24+6 weeks' gestation by dates, when ultrasound examination was performed, showing a very small common cloaca in the lower abdomen, absence of bladder, ambiguous genitalia and imperforate anus. Both mother and clinicians agreed on termination of pregnancy. The mother spontaneously delivered a dead female fetus weighing 1085 grams at 25+4 weeks' gestation after amniotic cavity injection rivanol, who had multiple congenital anomalies including imperforate anus, smooth perineum, absence of normal urethral and vaginal openings, absent bladder, uterus, vagina, and urethra, in combination with a very small common cloaca opening in the perinea and myelomeningocele in the sacral vertebrae. Conclusion: The characteristic features of the URSMS in ultrasonography are relate to the type of the URSMS, not all URSMS along with very dilated cystic regions in the abdomen.

Urinary Tract Infection, Incidence, Uropathogens and Antibiotic Sensitivity in Females

Introduction: Urinary tract infection in female population is one of the most common clinical infectious pathologies found worldwide due to anatomical location of urethral opening in relation to males. Continuous assessment of uropathogens and their sensitiveness to chemotherapeutic agent help us to manage these. The aim of this study to determine the presence of uropathpgens and their sensitkng from UTI.
 Method: It is a hospital based cross sectional study conducted at NGMC Teaching Hospital Kohalpur from July 2016 to June 2017. The urine samples were collected using the mid-stream clean catch method from 948 clinically suspected UTI female patients and the irantibiotic sensitiveness was determined using the standard procedures.
 Result: Overall culture positive was found in 262 patients (27.6%) among 948 urine samples. Among them e. coli contributed to cases 179(68.3%) followed by klebsiella 38(14.5%), enterobacter 21(8%), fungal 10(3.9%).Maximum no. of uropathogens were sensitive to chloramphenicol 224(93.4%) followed by nitrofurantin 232(88.7%), amikacin 246(94%), tobramycin 241(92.8%) and gentamycin 229(85.5%). Most of the organism were found to be resistant with ampicillin 255(97.5%) followed by cefpodoxime 242(92.4%),
 vancomycin 235(90%) and amoxicillin 234(89.6).
 Conclusion: and recommendation – Chloramphenicol, Nitrofurantin, Amikacin, Gentamicin and Tobramycinare the drugs of choice for the empirical therapytill the culture and sensitivity report is available. Continuous assessment is required for the early diagnosis and management of UTI.The culture and the sensitiveness of uropathogen are to be done and the treatment should be modified accordingly.

Подходы к лечению инфекций нижних мочевыводящих путей у женщин репродуктивного возраста

Infections of urinary tracts (IUT) occupy a priority place both in the level of their outspread and the emergence of recurrences of the disease in ambulatory and stationary practice of a doctor; they are conditioned by inflammatory process, mostly of bacterial genesis, developed in different anatomic parts of urinary system – from fascia renalis to external urethral opening and often combined with pelvic inflammatory diseases. Purpose of research: to evaluate the effectiveness of complex therapy of chronic recidivating cystitis in combination with pelvic inflammatory diseases in women of reproductive age. Materials and Methods. A complex clinical and microbiological examination of 39 women aged from 18 to 39 having chronic reccurent cystitis in combination with pelvic inflammatory diseases in the observation dynamics (before and after the course of anti-inflammatory therapy with the inclusion of Tiflox and probiotic Lactovit Forte) was carried out. Results. As a result of the carried out research the symptomatic development of chronic reccurent cystitis at the background of latent development of pelvic inflammatory diseases was established. In the etiological spectre of chronic reccurent cystitis there were more often microorganisms (mostly E.coli – 82.1%) in the monoculture of critical and high number of microbs, and in 17 (43.5%) mixt-infection was established. Concordance when establishing Chlamydia (7.7%), Mycoplasmas (5.1%), Ureaplasmas (10.3%), Candida (33.4%), and Gardnerella vaginalis (10.3%) both in the biomaterial from urethra and genitals in comparison with the spectre of clinical characteristics certified the presence of interconnection of urinary and reproductive systems, which has to be considered when conducting complex anti-inflammatory therapy. Conclusion. Treatment of chronic reccurent cystitis should be conducted considering the heaviness and level of changes in the inflammatory process both from the side of urinary and reproductive systems in a single context. Only after the clinical analysis of all factors in combination it is possible to determine the tactics of treatment of infections of urinary system in women of reproductive age with the prescription of grounded and adequate therapy. Key words: infections of lower urinary tracts, pelvic inflammatory diseases, women of reproductive age, diagnostics, treatment of acute and chronic recurrent cystitis, Tiflox, Lactovit Forte.

Hypospadias, Intrauterine Growth Restriction, and Abnormalities of the Placenta

Hypospadias is more common among male infants with growth restriction, defined as a birth weight less than the 10th centile, than in infants with a normal birth weight. Intrauterine growth retardation (IUGR) has been associated, also, with abnormalities of the placenta, such as maternal vascular malperfusion. In a consecutive sample of newborn infants, the association between hypospadias, IUGR and abnormalities of the placenta could be analyzed. Affected infants were identified among 289,365 liveborn and stillborn infants in the Active Malformations Surveillance Program between 1972 and 2012. The four anatomic locations of the ectopic urethral opening, based on the recorded physical examination findings, were: (1) glandular; (2) subcoronal; (3) penile; (4) penoscrotal. Affected infants with associated malformations, a chromosome abnormality, teratogenic exposure, maternal diabetes mellitus, or multiple gestations were excluded. Three hundred sixteen affected infants were identified: 52.2% glandular, 11.7% subcoronal, 27.8% penile, and 8.2% penoscrotal. The highest frequency of IUGR (34.6%) was in the infants with the most severe hypospadias (penoscrotal). The 39 reports of placenta findings showed a high frequency of abnormalities. An increased rate of occurrence of hypospadias and abnormalities of the placenta were present in infants with intrauterine growth restriction. The postulated cause of this association is a deficiency in the function of the placenta during weeks 10 to 14 of gestation when normal masculinization occurs due to an increase in the level of placental human chorionic gonadotropin and fetal testosterone. The cause of the placental deficiency has not been established. Birth Defects Research 110:122-127, 2018.© 2017 Wiley Periodicals, Inc.

Congenital prepubic sinus (an epispadiac variant of dorsal urethral duplication) with dorsal penile curvature in an adult man: a rare association

Urethral duplication is among a very rare congenital disorder with multiple anatomical variants reported. Urethral duplication of complete type is usually diagnosed during childhood with urinary incontinence or double urinary...

Un caso de desorden del desarrollo sexual en un canino mestizo

The disorders of sex development can occur in different domestic animals, but they are not very common. They are classified as sex chromosomic disorders, gonadal sex development disorders andphenotypic sex disorders and have different subcategories. The aim of this study was to describe the phenotypic, chromosomal and anatomical traits of the reproductive organs of a canine patient 3-year-old, apparently female with disorder of sexual development, which presented a protuberance into the vagina with bleeding andpus, which anamnesis male behavior report. A general examination was performed by systems, ventral abdominal ultrasound,latero-lateral radiography, blood count and karyotype whit R-replicative bands. After the evaluation found an enlarged clitoris (pseudopene) with urethral opening that showed resistance to placing a catheter. Radiography showed a structure similar to penis bone and the ultrasonography a structure consistent with the cervix in a female and a structure similar to gonadal tissue in the side. The karyotype was typical of a male, compatible with a male pseudo-hermaphrodite, which classifies the individual as XY with a phenotypic disorder of sex development (78, XY) according to the new classification. With the diagnostic tools found in Colombia is possible to make an appropriate differential diagnosis. But nevertheless, lack of availability of specific diagnostic tests such as FISH and serological measurements.

Current treatment of pelvic organ prolapse correlated with chronic pelvic pain, bladder and bowel dysfunction.

The purpose of this review is to critically analyze the relationship between symptoms of abnormal emptying of the bladder, urgency, pelvic pain, anorectal dysfunction and pelvic organ prolapse (POP) and to present evidence in order to show how many of the above mentioned symptoms can be cured or substantially improved by repair of specific pelvic ligaments. In this review, we provide evidence to show how often these dysfunctions occur and how they can be cured in 42-94% by appropriate pelvic floor surgery in the longer term, up to 2 years. Laxity in ligaments and/or vaginal membrane due to damaged connective tissue may prevent the normal opening and closure mechanism of urethra and anus, because muscles need finite lengths to contract properly. Hypermobility of the apex can irritate the pelvic plexus causing chronic pelvic pain. In consequence, dysfunctions as abnormal emptying of the bladder, urgency, pelvic pain, fecal incontinence and obstructed defecation can occur in women with different degrees of POP. In conclusion, it has to be recognized that women bothered by these symptoms should be examined for POP and appropriately advised for possibility of cure by pelvic floor surgery after careful selection. VIDEO ABSTRACT.

Invasive fungal infections: A diagnostic challenge

Introduction: Overall incidence of invasive fungal infections in solid organ transplant recipients is low with the more common infections being invasive candidiasis, aspergillosis and cryptococosis. Zygomycosis comprises of only 0.2%-1.2% of infections in renal transplant recipients with current recommendations advising against routine prophylaxis.Case: The patient was a 60-year-old male with a history of renal transplant 25 years ago on immunosuppressants, chronic transplant glomerulopathy, squamous cell carcinoma post penectomy and bilateral orchiectomy 2 years ago, controlled diabetes and hypertension who presented with pain in the perineal region for 4 days. On exam he was discovered to be afebrile and had a scrotal skin fold with urethral opening from his previous surgery and 2.5 cm induration and tenderness in the left gluteal fold. He was treated with 5 days of Unasyn. A biopsy was taken to rule out recurrence of squamous cell carcinoma and he was discharged home. The patient returned with worsening perineal pain within 3 days. On exam he had progressive induration with erythema, swelling and tenderness in the perineum. An initial white blood cell count of 15.8 increased to 25.8 and blood cultures remained negative. The computed tomography scan showed diffuse edema in the perineum without any evidence of abscesses. Immunosuppression was held and broad spectrum antibiotics were started. His renal failure progressively worsened eventually requiring continuous renal replacement therapy, intensive care transfer and vasopressor support. The biopsy revealed intermingled fibrous tissue with focal necrosis and no evidence of malignant cells. A repeat incision and debridement (I&D) culture showed growth consistent with mucor. He was started on liposomal amphotericin B and taken to the OR for multiple debridements. Unfortunately he progressed to multisystem organ failure and died after transitioning to comfort care.Conclusions: Invasive fungal infections remain one of the life threatening differentials for cellulitis like skin lesions, especially for patients not responding to antibiotics and those who are immunocompromised. Early cultures and histopathology of lesions should be done for diagnosis and to avoid delays in treatment.

Urethrocutaneous fistula mimicking vesicocutaneous fistula: a rare entity

Urethral fistulas arising from the anterior urethra usually open on the ventral aspect and are located in the penile, scrotal or perineal region. A diabetic 65-year-old man presented with suprapubic...

MP42-08 MALE URETHRAL SPHINCTER COMPLEX REVISITED USING NOVEL MR IMAGING TECHNIQUES

You have accessJournal of UrologyBladder & Urethra: Anatomy, Physiology & Pharmacology I1 Apr 2017MP42-08 MALE URETHRAL SPHINCTER COMPLEX REVISITED USING NOVEL MR IMAGING TECHNIQUES Kyoko Sakamoto, Valmik Bhargava, Vadim Malis, M. Raj Rajasekaran, and Shantanu Sinha Kyoko SakamotoKyoko Sakamoto More articles by this author , Valmik BhargavaValmik Bhargava More articles by this author , Vadim MalisVadim Malis More articles by this author , M. Raj RajasekaranM. Raj Rajasekaran More articles by this author , and Shantanu SinhaShantanu Sinha More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1297AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anatomical description of the male urethral sphincter complex (internal lissospincter and external rhabdosphincter) has undergone several revisions as previous conclusions were mostly derived from gross cadaveric dissection of adult male pelvis. These findings have been plagued by distortions of the anatomical structures in cadavers. Our objective was to elucidate the anatomy of the urethral sphincter muscles by resorting to in vivo, non-invasive imaging, using proton-density (PD), diffusion tensor imaging (DTI) and fiber tracking and thereby improve our understanding by avoiding the errors in cadaveric studies. METHODS Normal healthy five male young subjects, (mean age ~25 yrs) were scanned on a 3T GE MR scanner, using a multi-channel cardiac coil, lying supine, feet-first. After acquisition of a high resolution sagittal scout scan (Fig. A), axial morphological proton-density scans were prescribed and acquired extending from a few slices below the base of the bladder to beyond the entry of the urethra into the penis (~18-22 slices depending on the height of the subject). Three mm thick DTI scans were acquired and analyzed to obtain first the tensor axial images (Fig. B-C) to construct fibers within this urethral complex. RESULTS A consistent finding was that of possibly two sphincter like muscles (Fig. D-E), with one proximal near the bladder neck (yellow arrow in Fig. A, B) and the other more distal (Fig. C). In the tensor images, blue color indicates fibers oriented superior- inferior, red left-right while green anterior-posterior directions. Fiber tracking of these tensor images yields fiber structures within the urethral sphincter complex. The proximal sphincter is shown in Fig. D, the distal sphincter in Fig. E. The connecting superior-inferior longitudinal fibers are shown in blue in Fig. F. A consistent finding was the distance between the two sphincters is between 21 and 24 mm (i.e., 7 to 8 slices). CONCLUSIONS This is perhaps the first DTI and fiber tracking of the male urethral sphincter complex. Our findings support the two sphincter concept to constrict/close the urethral opening. These observations will form the basis of normal urethral morphology that can be monitored in post-surgery patients and correlated with age /urinary incontinence symptoms. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e546-e547 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kyoko Sakamoto More articles by this author Valmik Bhargava More articles by this author Vadim Malis More articles by this author M. Raj Rajasekaran More articles by this author Shantanu Sinha More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of benign prostatic hyperplasia: A cystometric and clinicopathological study

Background: Benign prostatic hyperplasia (BPH) is characterized by the nonmalignant overgrowth of prostatic tissue surrounding the urethra, ultimately constricting the urethral opening, and giving rise to associated lower urinary tract symptoms. Objectives: Diagnosis of BPH is made based on histologic examination of prostatic tissue. This study aimed to evaluate the clinicopathological and cystometric changes in BPH patients. Materials and Methods: In this study, 61 elderly males who were suffering from clinical BPH were included. Patients of different age groups ranging from 50 to 80 years and more were considered. All patients were undergone clinical, urine examination, and ultrasound scan was performed to confirm the hypothesis. The patients were divided into three subgroups according to the International Prostate Symptom Score as mild, moderate, and severe. Results: In mild group of patients, the mean compliance was 44.11; in moderate, it was 21.90; and in severe group, it was 17.54. Conclusion: This study concluded that as severity of bladder outlet obstruction increases, the compliance of bladder decreases. Cystometric evaluation of bladder compliance should be an essential part in pre-operative evaluation of symptomatic BPH patients.

Congenital Pouch Colon.

Congenital pouch colon (CPC) is an unusual abnormality in which a pouch-like dilatation of a shortened colon is associated with an anorectal malformation. It is categorized into four subtypes (Types I–IV) based on the length of normal colon proximal to the colonic pouch. In males, the pouch usually terminates in a colovesical fistula just proximal to the bladder neck. In girls, the terminal fistula opens either into the urethra or in the vestibule, close to the urethral opening. Girls usually have a double vagina with a wide inter-vaginal bridge, a monocornuate uterus on each side, and urinary incontinence due to a widely open bladder neck. Associated major malformations are uncommon with CPC but sometimes, especially in reports from outside India, major abnormalities are present suggesting an early, severe error in embryogenesis. The more severe Types I/II CPC can usually be diagnosed by a large gas shadow or air-fluid level on X-Ray abdomen. For all subtypes of CPC, it is preferable to preserve a segment of the pouch by fashioning a narrow colonic tube for pull-through, the technique known as coloplasty or tubular colorraphy. Girls need additional management of the genitourinary abnormalities. Postoperatively, fecal continence levels are usually poor, especially with Types I/II CPC.

A surprise during hypospadias repair: A rare case of urethral duplication with review of literature

Urethral duplication (UD) is a rare congenital anomaly mainly affecting boys. This article highlights a case of UD which was incidentally diagnosed during hypospadias repair. It was an incomplete UD with an accessory channel opening orthotopically and primary urethral opening being hypospadiac. The patient underwent glansplasty and excision of distal septum between the two urethrae to make it into a single channel following which he was asymptomatic.

Appearance of external genital organs and types of hymen in Turkish female foetal cadavers

The present study’s purpose was to determine the size and morphometric development of the female external genital organs on foetal cadavers. Dimensions of labia majora, labia minora and clitoris, bilabial diameter, vertical and horizontal diameters of hymenal opening, distance between the external urethral orifice and hymenal opening, distance between the clitoris and external urethral orifice and anogenital distance were measured. The hymenal types were determined. Mean values of parameters according to gestational weeks, months and trimesters were calculated. Imperforate hymen were determined in the first trimester. Twenty-eight foetuses with annular hymen, 25 foetuses with imperforate hymen, and 1 foetus with septated hymen were determined in the second trimester. Twenty-four foetuses with annular hymen, 3 foetuses with imperforate hymen, 1 foetus with fimbriated hymen, and 1 foetus with hymenal tag were determined in the third trimester. All foetuses in the full term were determined with annular hymen.

Urethral pressure reflectometry in women with pelvic organ prolapse: a study of reproducibility.

The mechanism of continence in women with pelvic organ prolapse (POP) before and after surgery remains unknown. Urethral pressure reflectometry (UPR) separates women with stress urinary incontinence (SUI) from continent women by measuring urethral opening pressure at an abdominal pressure of 50cmH2O (P O-Abd 50). UPR can help identify women with POP at risk of postoperative de novo SUI. The aim of this study was to investigate the reproducibility of UPR in women with POP. Women with anterior or posterior vaginal wall prolapse were recruited for this prospective, observational study from our outpatient clinic. The women were examined with UPR on two occasions. Measurements were done at rest, and during squeezing and straining. Statistical analyses were performed using SAS 9.4. A Bland-Altman analysis with limits of agreement and coefficients of variation was used to determine the level of agreement between measurements. Paired t tests were used to estimate the difference; a two-tailed P value of <0.05 was considered significant. We recruited 19 women with anterior vaginal wall prolapse and 11 women with posterior vaginal wall prolapse. There were no significant differences in the opening pressures at rest or during squeezing or in the values of P O-Abd 50. P O-Abd 50 showed limits of agreement of 15.3cmH2O and a coefficient of variation of 9.9%. UPR was found to be a highly reproducible method in women with POP. UPR may be used in future studies to help reveal urodynamic features predictive of postoperative de novo SUI in women with POP.

A prospective study of calorimetric estimation of blood loss in TURP cases

Introduction: BEP is hyperplasia of prostatic stromal epithelial cells to form discreate nodules in transitional zone of prostate. It leads to constriction of urethral opening which gives rise to associated lower urinary tract symptoms such as frequency, urgency, nocturia. Initially disease can be managed by drug treatment but eventually most of the patients require surgical management. TURP remains gold standard treatment. Blood loss during and after procedure is major problem. This study was planned to evaluate the approximate blood loss with the help of simple technique of colorimatry. Method: This study is carried out on 50 patients with BEP who underwent TURP in our institute from October 2014 and June 2015. Irrigation fluid collected during TURP, post operative day 1 & 2 subjected to calorimetric estimation of blood loss using Drabkin’s reagent. Results: The results were suggestive of approximate average blood loss during TURP procedure as 267 ml, post operative day 1 blood loss 98.9ml and post operative day 2 loss was 58.1ml. However the average blood loss changes according to the size of prostate and duration of the procedure. Conclusion: calorimetric estimation of blood loss during and post operative period is an easy, economically feasible, quick method to guide the management of blood requirement for the patient. This can be useful in patients with BEP and bleeding diathesis.

Congenital Anomalies of the Male Genitalia and Risk of Autism Spectrum Disorders

Introduction Prenatal exposure to ortho-phthalates has been suggested as a possible risk factor for Autism Spectrum Disorders (ASD) through their anti-androgenic activity. In rats, prenatal exposure to phthalates causes hypospadias (abnormal positioning of the urethral opening) and cryptorchidism (undescended testis), two common male reproductive tract disorders. An ecological analysis of human newborn infants showed a strong correlation between these two disorders and ASD, but this association has not been extensively studied on an individual level. Methods We analyzed all male singleton live births (n=147,171) from January 1, 1999 through December 31, 2008 occurring in a large Israeli healthcare organization. Boys with cryptorchidism (n=3,649) or hypospadias (n=2,342) were identified via ICD-9 codes. ASD cases (n=1,329) were identified by ICD-9 code and verified by review of medical records. Analyses were conducted using generalized additive mixed effect models with random component accounting for family clusters. Results In multivariable-adjusted analyses, the odds ratio (OR) for ASD among boys with hypospadias or cryptorchidism was 1.31 (95% confidence interval (CI): 1.01-1.68). For cryptorchidism only the OR was 1.44 (95% CI: 1.06-1.96) and for hypospadias only was 1.07 (95% CI: 0.70-1.64). Restricting to boys who underwent surgical correction strengthened the results for cryptorchidism (OR: 1.77; 95% CI: 1.16-2.72), but not hypospadias. Conclusions Boys with cryptorchidism were at higher risk of ASD, but we did not observe an increased risk among boys with hypospadias. Differences in ASD risk between the disorders may reflect variations in critical windows of exposure to a hypoandrogenic in-utero environment, or effects of other singling systems involved in the etiology of the disorders. Understanding the links between cryptorchidism and ASD could shed light on mechanisms of ASD pathogenesis.

Psychosexual Outcome of Men with Non-Corrected Hypospadias

Objective: Hypospadias is a common penile malformation, in which the urethral opening is on the underside of the penis. It is usually surgically corrected in early childhood. Severe types of hypospadias are corrected to solve functional problems. Mild types are mainly operated to achieve a better cosmetic result under the assumption that surgery improves psychosexual adjustment and quality of life. However, data on the outcome of non-operated men is scarce and therefore, this assumption is not evidence based. This study compares psychosexual outcome of men with non-corrected hypospadias to men without a genital malformation. Design and Method: In an ongoing cross-sectional survey, 21 men with noncorrected hypospadias (mean age: 48.71 years, SD: 10.33) and a control group of 21 age matched, non-affected men (mean age: 48.05 years, SD: 9.72) were asked to answer a penile self-perception score (PPS) and a questionnaire regarding their psychosexual adjustment. Results: Men with non-corrected hypospadias and controls reported the same level of sexual satisfaction and number of sexual partners. Men with non-corrected hypospadias were neither more often ashamed nor more often bothered because of their penile appearance. However, they had significantly less positive PPS. Conclusions: Although men with non-corrected hypospadias had an impaired penile self-perception, they were neither ashamed nor bothered due to their penile appearance and they reported the same level of sexual satisfaction as non-affected men. These results suggest that there is a subgroup of men with non-severe types of hypospadias, who do not suffer if left without surgical correction for their hypospadias in childhood.

Age of the mother as a risk factor and timing of hypospadias repair according to severity.

Hypospadias is characterized by a displacement of the urethral opening in males that can change from the typical position within the glans penis to a subcoronal position (Type I), to anywhere along the ventral shaft (Type II), to penoscrotal, scrotal, or perineal positions (Type III). We and others have previously reported that age of the mother (≥ 40 years old) is a risk factor for having a child with hypospadias, but there is a scarcity of reports on whether such risk is higher for having a child with the mild (Type I) or the more severe forms (Types II and III). In addition, we aimed to assess the timing of hypospadias repair according to severity. Parents of children with hypospadias were interviewed by using a series of questionnaires (n = 128 cases). Severity was confirmed in the clinic and age of the mother was self-reported. Number of surgeries, age of child by the first and the last intervention was also assessed. Ordered logistic regression and the Brant test were employed to calculate risk between mild (Type I) and severe cases (Types II and III), and the assumption of proportional odds, respectively. The Mann-Whitney U Test was used to compare number of surgeries and age by the last repair between mild and severe cases. One-way ANOVA was employed to compare age of the child at the time of first surgery across severities (Types I - III). Women ≥ 40 years of age are 3.89 times [95% CI: 1.20-12.64] at a higher risk for having a child with the more severe forms of the condition than younger women. Repair of Type I was accomplished with 1 intervention whereas more severe cases required 1 - 4 (2 ± 0.5) surgical interventions. The timing for hypospadias repair of Type I cases occurred at an average age of 16.2 ± 4.88 months, of Type II cases occurred at an average age of 20.3 ± 8.15 months whereas the average age of the first hypospadias repair among Type III cases was 12.68 ± 2.52 months. Number of surgeries according to severity (p ≤ 0.0018, z-ratio = 2.91) and age difference for the timing of last repair (p ≤ 0.045, z-ratio = 1.69) were statistically different, but not the age difference for the first repair. Increased maternal age is associated with the most severe forms of hypospadias. There is room for improvement for the timing of hypospadias repair according to severity.