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Hypospadias (Endocrine Evaluation)

Congenital urethral malformation with endocrinologic considerations involving disorders of sex development

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Hypospadias (Endocrine Evaluation)?

Hypospadias affects approximately 1 in 200-300 male births and represents incomplete urethral plate fusion during embryogenesis (between weeks 8-14).

Classified by meatal location: distal (glanular, coronal), midshaft, proximal (penoscrotal, perineal).

Proximal and severe forms warrant endocrine workup for hormonal abnormalities or DSD.

Associated anomalies include chordee (penile curvature), cryptorchidism, micropenis, and bifid scrotum.

Endocrine evaluation includes karyotype, gonadotropins, testosterone, dihydrotestosterone, and adrenal hormones.

Surgical correction typically performed between 6-18 months of age.

Symptoms

Abnormal urethral opening on ventral surface of penis (anywhere from glans to perineum).
Downward curvature of penis (chordee), particularly during erection.
Hooded foreskin appearance (incomplete dorsal foreskin).
Abnormal stream during urination - downward or split stream.
Associated cryptorchidism (undescended testis) in 8-10 percent of cases.
Severe forms with proximal opening, micropenis, or genital ambiguity warrant DSD evaluation.

Risk Factors

Genetic predisposition (familial cases in 10-20 percent).
Maternal factors: advanced age, in vitro fertilization, hypertensive disorders.
Environmental endocrine disruptors: phthalates, pesticides, exposure during early pregnancy.
Maternal diet low in fish/meat, vegetarianism (controversial).
Placental insufficiency, intrauterine growth restriction.
Disorders of sex development (5α-reductase deficiency, partial androgen insensitivity, mixed gonadal dysgenesis).

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Newborn examination revealing abnormal urethral position - urology referral.
  • Severe hypospadias (proximal/perineal) or micropenis - endocrine evaluation.
  • Bilateral cryptorchidism with hypospadias - urgent DSD workup.
  • Ambiguous genitalia at birth - multidisciplinary DSD team evaluation.
  • Family history of hypospadias or DSD - genetic counseling.
  • Postoperative complications: fistula, meatal stenosis, persistent chordee.

Treatment Methods

01
Avoid neonatal circumcision - foreskin needed for surgical reconstruction.
02
Endocrine workup if proximal hypospadias, micropenis, cryptorchidism: karyotype, AMH, testosterone, DHT, FSH/LH, 17-OHP.
03
Surgical repair (urethroplasty) at 6-18 months: TIP (tubularized incised plate) for distal; staged repair (Bracka, Byars) for proximal.
04
Preoperative testosterone (HCG or transdermal/IM) for severe cases to enhance penile growth.
05
Catheter drainage and antibiotics post-repair; complications include fistula (5-15 percent), stricture, dehiscence.
06
Multidisciplinary care for DSD: pediatric urology, endocrinology, genetics, psychology.
07
Long-term follow-up for cosmetic outcome, urinary function, sexual function in adolescence/adulthood.
08
Psychological support for child and family, particularly with severe forms or DSD diagnosis.

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.