Hypospadias and the Use of the Ages and Stages Questionnaire to Evaluate Neurodevelopmental Status of Boys with Hypospadias

Abstract

Introduction Placental insufficiency is one of the reasons for the reduction of hormone production. Thus, if one of the suspected causes of hypospadias is placental insufficiency, then the neurodevelopmental status of boys with hypospadias may be impaired. The aim of this study was to evaluate the neurodevelopmental status of boys with hypospadias and guide the parents of those who need support to related departments for early intervention. Materials and Methods Boys were divided into two groups, those with hypospadias (group H) and healthy children undergoing traditional circumcision (group C). The parents of the boys completed the Ages and Stages Questionnaire (ASQ) and ASQ–Social Emotional (SE), both of which are screening instruments for the early identification of developmental and social–emotional problems, respectively. Results Seventy-eight boys had hypospadias and 59 were admitted for traditional circumcision. The group H had statistically significant more impaired scores than group C in communication, gross motor, and personal–social skill sections. The multivariate logistic regression analysis revealed that hypospadias was the independent predictive factor for communication and personal–social skills. Conclusion Hypospadias and neurologic impairment may share common etiologic factors. Accordingly, physicians should keep in mind that if a boy presents with hypospadias, the possibility of having neurologic impairment is higher than normal population and early intervention has crucial importance. Every boy with hypospadias should be evaluated for neurodevelopmental status.

Hypospadias and Increased Risk for Psychiatric Symptoms in Both Childhood and Adolescence: A Literature Review

“…However, a cohort study developed by Ortqvist et al (18) indicated that psychiatric symptoms (i.e., affective, suicidal, and anxiety symptoms) were more common in hypospadias patients than the healthy controls, but these psychiatric illnesses did not have e markedly difference between the two groups as well as between the severity or phenotype groups. Besides, no statistical significant difference was observed in the four included studies (10,14,15,21). In line with these findings, Mureau et al (30) demonstrated that psychiatric impairments did not differ obviously between patients with hypospadias surgery and those who underwent surgery for an inguinal hernia.…”

“…According to the above evidence, six included studies ( 10 , 15 , 18 , 20 , 21 , 34 ) explicitly showed that there was a non-significant association between hypospadias and psychiatric illnesses, regardless of whether underwent the surgery or not, while eight included studies ( 11 – 14 , 16 , 19 , 23 , 24 ) suggested that patients with hypospadias had a significantly higher risk of psychiatric comorbidity than the controls. Since almost all the patients had received hypospadias surgery, when choosing the operative age, the psychiatric comorbidity should be considered comprehensively to achieve the optimal therapeutic effect.…”

“…Though hypospadias is one of the most common malformations, few studies focusing on its psychiatric comorbidity and the correlated data have been conflicting ( 31 ). Due to abnormal appearance in the penis with abnormal urination and erection ( 32 ), patients with hypospadias were vulnerable to suffering from stress and psychiatric difficulties on account of the negative effects on their social behaviors, school success, gender roles, and self-confidence ( 14 ). As illustrated in Table 1 , nearly half of the included studies (6/14, 47%) suggested that patients with hypospadias were clearly more liable to suffer from psychosocial disorders than the controls.…”

“…Sandberg et al had also confirmed the positive relationship between hypospadias and psychiatric morbidities, showing that emotional problems increased with the number of hospital-related experiences ( 29 ). Cakmak et al ( 14 ) demonstrated that hypospadias was an independent predictive factor for impairment of communication (odds ratio = 4.06, 95%CI: 1.32–13.37, P = 0.015) and personal-social (odds ratio = 5.7, 95%CI: 1.23–26.34, P = 0.026) skills impairment. However, a cohort study developed by Ortqvist et al ( 18 ) indicated that psychiatric symptoms (i.e., affective, suicidal, and anxiety symptoms) were more common in hypospadias patients than the healthy controls, but these psychiatric illnesses did not have e markedly difference between the two groups as well as between the severity or phenotype groups.…”

“…During the initial search, 1,606 records were identified, of which 567 were from MEDLINE, 411 from EMBASE, 347 from Cochrane Library, and 281 from PsychINFO database. Finally, 17 eligible clinical studies (3,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) containing with data met our predefined inclusion criteria. Six of these studies (13/17, 76%) had provided the data from both the hypospadias and the healthy control group.…”