The assessment of hypospadias

Hypospadias is a congenital anomaly involving the anterior urethra that can atTect both men and women. The dcfonnity is characterised by a dystopia of the extemal ori1ice of the urethra and can be associated with a curvahu'c of the penile body in male subjects. The incidence of hypospadias in men is estimated as one in two to three hundred live male bilths and seems to be increasing although it varies according to the registration system used, geographical area and racial influences I. The precise aetiology of this anomaly remains unclear, although certain risk factors can be assessed. For instance, hypospadias is known to cluster in families but little else is definitive about the genetics involved in its aetiology and it still seems to be a multifactorial anomaly 2-6. Early exposure to progestins in utero during organogenesis also appears to be of influence in the development of hypospadias with a twofold relative risk 7. Because of the sporadicness of this exposure and hypospadias it is, however, difficult to demonstrate a definitive association J. Another factor held responsible as a possible cause of hypospadias is a local vascular insufiiciency of the embryo during pregnancy~. The morphogenesis of the male external genital system and therefore the hypospadias def01l11ity as well, have been the subject of controversy in the past 9-11. Glenister, a lecturer at the Charing Cross Hospital Medical School in London, contributed a substantial amount of knowledge on thc development of the male external genital 9.12.13. His general concept of the cmbryogenesis of the male anterior urethra has had velY little opponents in the literature. Some details, such as the fonnation of the glandular part of the urethra or the onset of preputial dcvelopment, are challenged by others 14-18. Searching for cellbiological mechanisms like cell proliferation and apoptosis, responsible for normal development of the male genital system, it is striking to find nothing on this subject in the literahlre.

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