Hypospadias with cryptorchidism presented as ambiguous genitalia and its management with surgery

Authors

  • M. Nooruzzaman Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • A. K. M. Zahid Hossain Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • M. Kamrul Hassan Shabuj Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Susankar Kumar Mondal Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Noor Mahammad Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • K. M. Saiful Islam Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Umme Habiba Dilshad Munmun Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Tarafder Mohammad Atiquzzaman Department of Pediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-3291.ijcp20232234

Keywords:

Hypospadias, Cryptorchidism, Pediatric surgery

Abstract

Background: The incidence of hypospadias with cryptorchidism is about 6-31.6%. Current management recommendations are that undescended testis beyond three months needs surgery between 6-12 months of age. Proximal hypospadias and cryptorchidism overlap with disorders of sex development and endocrine problem. The aim of this study was to assess the outcome of surgical management of hypospadias with cryptorchidism, at selected centers in Dhaka, Bangladesh.

Methods: This prospective study was conducted in the Department of Pediatric Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from January, 2018 to January, 2022. In this study, we included 70 diagnosed cases of hypospadias with cryptorchidism presented as ambiguous genitalia who underwent surgery.

Results: Mean age at surgery was 4.6±1.4 years and majority (91.4%) were male. Associated renal anomalies were absent in 81.4% cases, symptomatic renal anomalies were present in 11% cases, severe chordee was 62.9%. Abnormal hemiscrotum was 98.6% and normal hemiscrotum was 1.4%. Hernia with cryptorchidism was present in 30 % cases. Testosterone was normal in 94.3% patients, estrogen and progesterone was elevated in 5.7% patients. After operation, male was 94.3% and female was 2.9%, chordee condition was corrected in 81.4% and urine passed through tip of penis in 84.3% patients.

Conclusions: We found that surgery is simple, safe, and effective in the treatment of patients with hypospadias and cryptorchidism with satisfactory functional results, normal physical health status, improved quality of life, satisfying psychological support and probably less pain.

References

Campbell M. Undescended testicle and hypospadias. Am J Surg. 1951;82(1):8-17.

Khuri FJ, Hardy BE, Churchill BM. Urologic anomalies associated with hypospadias. Urol Clin North Am. 1981;8(3):565-71.

Nelson CP, Park JM, Wan J. The increasing incidence of congenital penile anomalies in the United States. J Urol. 2005:174;1573-6.

Schnack TH, Poulsen G, Myrup C. Familial coaggregation of cryptorchidism and hypospadias. Epidemiology. 2010;21:109-13.

Boudaoud N, Pons M, Bouche MA, Lefebvre F, Poli Merol ML, Francois C. Hypospadias. Ann Chir Plast Esthét. 2016;61(5):439-49.

Duckett JW. Transverse preputial island fap technique for repair of severe hypospadias. Urol Clin North Am. 1980;7(2):423-30

Bankole Sapin R, Nandiolo R, Yao B, Tam- bo F, Vodi L, Mobiot L. Le traitement de l’hypospadias posterieur au CHU de Treichville (Abidjan). Prog Urol. 2007;17(4):860-2.

Sadeghi A, Mirshemirani A, Khaleghnejadtabari A, Sadeghian N, Rozroukh M, Ghoroubi J, et al. Duckett versus modifed Bracka technique for proximal hypospadias repair a 10-year experience. Iran J Pediatr. 2017;27(6):e7752

Ndiaye M, Sow Y, Sarr A. Hypospadias treatment by tubulated pedicled preputial island flap according to the DUCKETT technique: single-center experience in sub-Saharan Africa. Afr J Urol. 2021;27:156.

Sabetkish S, Kajbafzadeh AM, Sabetkish N. Hypospadias and concomitant undescended testis: Comparison of no skin incision with inguinal and scrotal skin incision orchiopexy. Int J Surg. 2015;22: 154-8.

Snodgrass W, Yucel S. Tubularized incised plate for mid shaft and proximal hypospadias repair. J Urol. 2007;177(2):698-702.

Mosharafa AA, Agbo-Panzo D, Priso R, Aubry E, Besson R. Cure d’hypospadias. La forme de la plaque urétrale a-t-elle une infuence sur le résultat de l’intervention de Duplay-Snodgrass? Prog Urol. 2009; 19(7):510-11.

Zheng DC, Yao HJ, Cai ZK, Da J, Chen Q, Chen YB, et al. Two stage urethroplastyis a better choice for proximal hypospadias with chordee after urethralplate transection : a sigle center experience. Asian J Androl. 2015;17(1):94-7.

Bhat A, Single M, Bhat M, Sabharwal K, Upadhay R, Kumar V. Incised plate uretroplasty in perinéal and périnéo-scrotal hypospadias. Afr J Urol. 2015;21:105-10.

Moudouni S, Tazi K, Nouri M, Koutani A, Hachimi M, Lakrissa A. Hypospadias in adults. Prog Urol. 2001;11(4):667-9.

Diallo AB, Bah I, Toure BM, Ouendeno LB, Balde I, Diallo MB. L’hypospadias: aspects anatomo-cliniques et thérapeutiques au CHU de Conakry Guinée. Andrologie 2008;18(2):131.

Spinoit AF, Poelaert F, Groen LA, Van Laecke E, Hoebeke P. Hypo spadias repair at a tertiary care center: long-term followup is mandatory to determine the real complication rate. J Urol. 2013;189(6):2276-81.

Akbiyik F, Tiryaki T, Şenel E, Mambet E, Livanelioglu Z, Atayurt H. Clinical experience in hypospadias: results of tabularized incised plate in 496 patients. Urology. 2009;73(6):1255-7.

Diao B, Fall PA, Ndoye AK, Diallo Y, Sow Y, Diabaté I, et al. Anterior hypospadias: one stage repair. Report of 40 cases. Dakar Med. 2006;51(3): 151-4.

Han W, Zhang W, Sun N. Risk factors for failed urethrocutaneous fistula repair after transverse prepucial island flap urethroplasty. Int Urol Nephrol. 2018;50(2):191-5.

Zheng DC, Wang H, Lu MJ, Chen Q, Chen YB, Ren XM, et al. A comparative study of the use of a transverse preputial island fap (the Duckett technique) to treat primary and secondary hypospadias in older chinese patients with severe chordee. World J Urol. 2013;31(4):965-9

Cheng EY, Vemulapalli SN, Kropp BP, Pope JC, Furness PD, Kaplan WE, et al. Snodgrass hypospadias repair with vascularized Dartos fap: the perfect repair for virgin cases of hypospadias. J Urol. 2002;4(2): 1723-6.

Dewan PA, Dinneen MD, Winkle D, Dufy PG, Ransley PG. Hypospa dias: Duckett Pedicle Tube Urethroplasty. Eur Urol. 1991;20:39-42

Bradshaw CJ, Corbet-Burcher G, Hitchcock R. Age at orchidopexy in the UK: has new evidence changed practice? J Pediatr Urol. 2014.

Comploj E, Pycha A. Diagnosis and management of cryptorchidism. Eur Urol Suppl. 2012;11(2):2.

Thorup H, McLachlan R, Cortes D. What is new in cryptorchidism and hypospadias-a critical review on the testicular dysgenesis hypothesis. J Pediatr Surg. 2010;45(10):2074.

Hutson JM, Clarke MC. Current management of the undescended testicle. Sem Pediatr Surg. 2007;16(1): 64.

Kurpisz A, Havryluk A, Nakonechnyi A. Cryptorchidism and longterm consequences. Reprod Biol. 2010;10(1):19.

Hutson JM. Undescended testis: the underlying mechanisms and the efects on germ cells that cause infertility and cancer. J Pediatr Surg. 2013;48(5):903.

Chen Y, Huang W, Huang K. Factors related to the time to cryptorchidism surgery: a nationwide, population-based study in Taiwan. J Formosan Med Assoc. 2013.

Walsh TJ, Dall’Era MA, Croughan MS. Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol. 2007;178(4): 1440.

Rogers E, Teahan S, Gallagher H. The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol. 1998;159(3):851.

Koni A, Ozseker HS, Arpali E. Histopathological evaluation of orchidectomy specimens in 51 late post pubertal men with unilateral cryptorchidism. J Urol. 2014.

Hutson JM, Balic A, Nation T. Cryptorchidism. Sem Pediatr Surg. 2010;19(3):215.

Kolon TF, Hemdon CD, Baker LA. Evaluation and treatment of cryptorchidism: AUA guidelines. J Urol. 2014;192(2):337.

Van Der Plas EM, Zijp GW, Froeling F. Long-term testicular volume after orchiopexy at diagnosis of acquired undescended testis. J Urol. 2013;190(1):257.

Wood HM, Jack S. Cryptorchidism and testicular cancer: separating fact from fction. J Urol. 2009; 181(2):452.

Chen Y, Huang W, Huang K. Factors related to the time to cryptorchidism surgery: a nationwide, population-based study in Taiwan. J Formosan Med Assoc. 2013.

Walsh TJ, Dall’Era MA, Croughan MS. Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol. 2007;178(4):1440.

Downloads

Published

2023-07-27

Issue

Section

Original Research Articles