Reports from Europe and the United States have indicated that there is an increasing incidence of hypospadias.  This study by Hussain et al involved two tertiary care neonatal intensive care units in Connecticut.  It was a retrospective study of 14 years of admissions.  It showed a 10-fold increase in hypospadias over the 14 years, from 0.4% of admissions in 1987 to 4% in the year 2000.  The increased occurrence of hypospadias among premature infants was associated with intrauterine growth retardation.  An increased frequency of hypospadias was also noted among the infants born in the lower percentiles (3^rd to 25^th).

An association of hypospadias with the smaller quartiles of head circumference (3^rd to 25^th) was also present.  The frequency was highest in first-born infants and those born to older mothers.  No association was noted with race, maternal diabetes, hypertension, or pre-eclampsia.  No specific teratogens were identified.  There does not seem to be an increase of a particular recognizable syndrome in spite of the association with intrauterine growth restriction.  The consistent involvement of all growth parameters, i.e., weight, length, and head circumference suggested that hypospadius is related to overall poor intrauterine growth. 

Editor’s Comment: A specific etiology for the observed increase in hypospadias does not seem to be forthcoming.  These are obviously real concerns with such a striking change over the last decade.  The question of endocrine disrupters and the association of advancing maternal age are important, but no real clarity exists as to their real role at this time.

Judith G. Hall, OC, MD