Prenatal diagnosis of hypospadias with 2-dimensional and 3-dimensional ultrasonography

Abstract

To compare the prenatal diagnostic performance as well as appearance of ultrasonic details between 2-dimensional ultrasonography (2DUS) combined with 3-dimensional ultrasonography (3DUS) and 2DUS alone for hypospadias. A total of 47 fetuses were enrolled and examined by 2DUS and then 3DUS. Postnatal follow-up data were obtained and 28 cases were confirmed of hypospadias. Although not statistically significant, there was a trend toward higher AUC (0.85 vs. 0.76; p = 0.08), ACC (85.1 vs. 76.6%; p = 0.22), SEN (85.7 vs. 78.6%; p = 0.63), and SPE (84.2 vs. 73.7%; p = 0.50) for 2DUS combined with 3DUS compared with 2DUS alone. The agreement between both methods was moderate [kappa = 0.592]. Both modalities showed accurately the short penis and blunt tip of the penis. 2DUS in combination with 3DUS showed more cases in other detailed features, such as "chordee", a "hooded" incomplete prepuce, and so on. Overall 2DUS combined with 3DUS showed a trend toward higher performance compared with 2DUS alone for the diagnosis of hypospadias, although the difference was not statistically significant. 3DUS is a useful complement for 2DUS in the diagnosis of fetal hypospadias and may provide more detailed information related to its diagnosis and prognosis.

Figure 1

Comparison of the area under receiver operating characteristics curves (ROC) for 2DUS combined with 3DUS and 2DUS alone. There was a trend toward higher AUC (0.85 vs. 0.76; p = 0.08) for 2DUS combined with 3DUS compared with 2DUS alone, although the difference was not statistically significant. Model 1 indicates 2DUS alone, and Model 2, 2DUS combined with 3DUS.

Figure 2

Three-dimensional multiplanar images of the external genitalia at 21 weeks of gestation in longitudinal (top left), axial (top right), and coronal (bottom left) views allow construction of a surface-rendered image (bottom right). A short and incurved penile shaft with a blunt tip was shown in three orthogonal planes simultaneously. Three-dimensional image in surface-rendered view shows excess dorsal prepuce (dorsal hood).

Figure 3

The ventral view of the penis was demonstrated by surface-rendered three-dimensional image at 28 weeks of gestation. The short penis with a shallow groove in the direction of up and down resulted from the incomplete fusion of the urogenital folds is shown (arrow).

Figure 4

Photograph of the newborn confirms the hypospadias. The dorsal thickened prepuce (big arrow) and ventral urethral groove (small arrow) of the penis are shown.