Urinary Tract Evaluation in Hypospadias

Vol. 94, Oct.

THE JOURNAL OF UROLOGY

Printed in l'.S.A.

Copyright© 1965 by The Williams & Wilkins Co,

URINARY TRACT EVALUATION IN HYPOSPADIAS M. ARTHUR NEYMAN*

AND

HORST K.A. SCHIRMER

From the James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland

One hundred and five cases of hypospadias treated at the Brady Urological Institute of The Johns Hopkins Hospital for the past 10 years were reviewed to determine the value of complete urological investigation in these patients. According to Campbell, "in a third of the cases of external genital malformation, the upper tract is also anomalous." 1 Our data on hypospadias tend to substantiate this statement. Radiologic evaluation of the urinary tract was performed on 37 patients (32.2 per cent). Excretory urograms were made and, if indicated, were supplemented with cystourethrograms. Nine patients had anomalies of the urinary tract in addition to the external genital malformation (table 1). Only one of the 37 patients had symptoms of urinary tract disease. (He was found to have bilateral ureteral reflux with ureteral ectasia.) The remaining patients were asymptomatic. Table 2 correlates the degree of hypospadias TABLE 1. Urinary tract anomalies associated with hypospadias Bladder neck obstruction Ureteropelvic junction obstruction Ectopic kidney Dysplastic left kidney Posterior urethral valve Bilateral ureteral reflux and ureteral ectasia Total

2 2 2 1 1 1

9

TABLE 2 No.

Type of Hypospadias

Coronal Penile Penoscrotal Perineal

No. Cases Evaluated

Cases Radiologically

32 37 29 7

12 11 10

4

No. Urinary Tract Abnormalities

3 2 3 1

(25%) (18.2%) (30%) (25%)

with the percentage of abnormal urinary tracts. These figures support the thesis that all patients with hypospadias should undergo thorough urological investigation inasmuch as 25 per cent of even the mildest form of hypospadias is associated with upper urinary tract anomalies. Our series contained a significantly higher percentage of renal, meteral, and vesical malformations than that reported by Felton (11.3 per cent) 2 or Kennedy (5.5 per cent). 3 Congenital anomalies other than those found in the urogenital system were discovered in 13 patients. Six of these (46.2 per cent) had anomalies of the upper urinary tracts. This paper is presented as evidence of the high correlation between hypospadias and upper urinary tract anomalies. The fact that hypospadias in this series is associated with a 24.5 per cent incidence of additional congenital anomalies emphasizes the necessity for careful urologic evaluation in order to uncover any that are silent, but potentially life-threatening. A plea is made for excretory urography in all cases of hypospadias.

Accepted for publication January 25, 1965. * Present address. Hahnemann Urologic Service, Philadelphia, General Hospital, Philadelphia, Pennsylvania. 1 Campbell, M.: Indications for urologic examination in children. Pediat. Olin. N. Amer., 2:

3 Kennedy, P.A., Jr.: Hypospadias: a twentyyear review of 489 cases. J. Urol., 85: 814-817,

653-661, 1955.

1961.

439

2 Felton, L. M.: Should intravenous pyelography be routine procedure for children with cryptorchism or hypospadias? J. Urol., 81: 335-

338, 1959.