Detection and incidence of anomalies associated with hypospadias

Hypospadias has been associated with synchronous congenital anomalies, especially in the urogenital system, and routine screening of patients with hypospadias has been advocated. In recent years, ultrasound (US) has replaced intravenous pyelography (IVP) as the primary screening test for urological deformities, yet there has never been a study of the relative diagnostic efficacy of the two tests in these patients. In this study, we assessed the incidence of urogenital and extraurogenital congenital anomalies in our hypospadias patients that were noted during physical examination and/or laboratory and imaging screening, and evaluated the efficacy of our changing routine screening protocols. We conducted a retrospective analysis of the charts of all hypospadias patients seen at Assaf Harofeh Medical Center. One hundred and sixty-three hypospadias patients fulfilled the documentation criteria we set for this study. We found a high incidence of urogenital and extraurogenital anomalies associated with hypospadias and noted a previously unreported increased incidence of various forms of facial dysmorphism. Additionally, we noted that the accepted concept that US or IVP alone were satisfactory screening tools for asymptomatic low-grade hypospadias patients is probably incorrect. Based on our findings, we recommend that initial screening of all asymptomatic hypospadias patients include US, cystogram, urinalysis, and urine culture.