Fertility Potential in Adult Hypospadias

Abstract

IntrOductIOnHypospadias is a congenital anomaly of the urogenital tract which results from an arrest in normal development of urethra, foreskin and ventral aspect of the penis. The phenotype ranges from a mild degree with distal glanular meatus to severe cases with ambiguous genitalia. The incidence is 3.2 per 1000 live male births [1]. The ideal time to correct primary hypospadias is when aged 6-12 months. However, in some developing countries, such as ours, this anomaly may be left untreated until adulthood. A multifactorial aetiology including genetic, endocrine and environmental factors are considered to be involved in the genesis of this anomaly [2]. There is a definite role of paternal abnormalities like scrotal or testicular defect, low sperm motility and abnormal sperm morphology in genesis of hypospadias [3], but the fertility potential of hypospadiac patient has not been clearly defined. The sexual function of patients who have either paediatric or adult hypospadias correction remains one of the enigmatic problems frequently raised by patients. As the child grows into adulthood, sexual function becomes an important issue. There are only few studies in the literature that focus on the sexual function, semen quality and reproductive hormonal profile, the results of these studies are somewhat discordant [4][5][6][7][8]. All these studies were done in group of adult hypospadiac patients who were operated in childhood. To the best of our knowledge, a study assessing the fertility potential in hypospadiac patients, who were operated in adulthood is not available. We hereby attempt to evaluate the fertility potential in hypospadiac patients as compared to age matched healthy controls along with effect of age of surgical correction over fertility potential in hypospadiac patients. MAtErIALS And MEtHOdSThe present study was carried out in the Department of Urology, SMS Medical College Jaipur, Rajasthan, India from September 2013 to December 2015. After ethical clearance from the institutional ethics committee, 86 cases of adult hypospadiac patients with Tanner stage 5 [9] at the time of evaluation were included in this study. Out of 86 patients, 56 were operated during the above study period and rest 30 patients were taken from urology outpatient department clinic, who were operated during childhood and attended the clinic for a variety of reasons, including renal calculus disease, minor degree of lower urinay tract symptoms, symptoms of non-specific flank pain or infertility. All these 30 patients were selected on the basis of discharge card provided by them. Patients with urethral stricture and multiple

Fertility in adult men born with hypospadias: A nationwide register‐based cohort study on birthrates, the use of assisted reproductive technologies and infertility

“…A few previous studies have investigated the fertility potential and birthrates in men with hypospadias . Most show a lower rate of children, although not always significant and, when available, the findings support the notion that men with proximal hypospadias have a lower fertility compared with men with distal hypospadias and controls, which is in accordance with our results.…”

“…In other studies, semen quality in men with isolated or distal hypospadias was comparable with those of healthy controls . Nonetheless, a recent Swedish study on men with proximal hypospadias reported lower fertility as compared with individuals with distal hypospadias and controls …”

“…A persisting chordee and surgical complications may impose an obstacle to having intercourse and can affect the ejaculation process, as reported by adults operated due to hypospadias . Impaired sexual functioning in men with hypospadias has been described, though recent studies have reported more positive outcomes . Furthermore, the etiology of hypospadias may affect fertility.…”

“…1,2 Impaired sexual functioning in men with hypospadias has been described, 3 though recent studies have reported more positive outcomes. 1,2,4,5 Furthermore, the etiology of hypospadias may affect fertility. The genetic origin of hypospadias and associated conditions such as cryptorchidism may affect fertility.…”

Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

“…56 A recent review of 93 adults with hypospadias presenting to a reconstructive urologist highlight the long-term issues that can occur following childhood repairs, including lower urinary tract symptoms (55%) and significant rate of urethral stricture (47%), although there is a selection bias in this study. 57 Long-term sexual issues, such as erectile dysfunction, 58 ejaculatory difficulties, 59 lower self-esteem, teasing, and negative genital perception, have been reported in patients with hypospadias. 60,61 Several studies have found overall sexual function to be equivalent or slightly lower compared to controls.…”