Intrauterine growth restriction and hypospadias: is there a connection?

Abstract

Hypospadias is one of the most common congenital malformations of the genitourinary tract in males. It is an incomplete fusion of urethral folds early in fetal development and may be associated with other malformations of the genital tract. The etiology is poorly understood and may be hormonal, genetic, or environmental, but most often is idiopathic or multifactorial. Among many possible risk factors identified, of particular importance is low birth weight, which is defined in various ways in the literature. No mechanism has been identified for the association of low birth weight and hypospadias, but some authors propose placental insufficiency as a common inciting factor. Currently, there is no standardized approach for evaluating children with hypospadias in the setting of intrauterine growth restriction. We reviewed the available published literature on the association of hypospadias and growth restriction to determine whether it should be considered a separate entity within the category of disorders of sexual differentiation.

Keywords: Fetal growth restriction; Hypospadias; Intrauterine growth restriction; Low birth weight; Placental insufficiency; Small for gestational age.

Figure 1

Proposed diagnostic algorithm for initial hormonal and genetic testing for etiology of hypospadias in setting of IUGR.

Figure 2

Diagram of commonly used classifications of hypospadias, based on location of urethral meatus. These categories were described by Boisen [70], Duckett [71], Hadidi [72], and Smith [73].