Craniofacial anomalies associated with hypospadias. Description of a hospital based population in South America

Surgical management of penoscrotal hypospadias in a child with Opitz G/BBB syndrome: a case report

Opitz G/BBB syndrome is a rare condition characterized by three significant anomalies; hypertelorism, cleft lip and palate, and hypospadias. However, other anomalies may be associated. Herein, we report a 4-year-old child presented with penoscrotal hypospadias. On examination, hypertelorism and cleft lip and palate were noticed, suggesting a diagnosis of Opitz G/BBB syndrome. The cleft lip was corrected in the first year, and a two-staged surgical approach was implemented for penoscrotal hypospadias. In the first stage, the chordee was corrected and urethral plate was reconstructed using a tabularized incised plate urethroplasty and testicular tunica vaginalis flap. In the second stage, the remanent hypospadias was corrected, and the meatal opening reached its normal location. In conclusion, a two-staged surgical approach for the treatment of penoscrotal hypospadias associated with Opitz G/BBB syndrome may provide excellent outcomes in early-recognized cases. The urologist should pay attention to abnormal facial characteristics in patients with hypospadias.

Bite force assessment before and after orthognathic surgery in individuals with repaired cleft lip and palate

OBJECTIVE

To evaluate the impact of orthognathic surgery on the masticatory system of individuals with repaired cleft lip and palate (CLP) by means of bite force (BF) assessment.

MATERIAL AND METHODS

Forty individuals were prospectively divided into 2 groups: 1) Control group (CON): 20 individuals without CLP (10 males, 10 females, 23.7y±7.4), 2) Cleft lip and palate group (CLP): 20 individuals with complete CLP with indication for orthognathic surgery (OS) (11 males, 9 females, 23.6y±5.6; 10 unilateral CLP; 10 bilateral CLP). The BF was evaluated in the immediate preoperative period (PRE), 3 months postoperatively (POST3M) and 6 months postoperatively (POST6M), using a gnathodynamometer (IDDK Kratos, Cotia-SP, Brazil).

RESULTS

The BF of the CLP group was significantly lower than that of the CON in all evaluated periods. The BF of individuals with CLP was significantly lower in POST3M compared to PRE. Also, a significant increase in BF was observed between POST3M and POST6M. Though not significant, the BF was increased in POST6M when compared to PRE. The BF of unilateral and bilateral CLP individuals were statistically similar. Males presented a BF almost twice as high as females.

CONCLUSION

Cleft lip and palate negatively impacts BF. Although there was a tendency for BF values to increase 6 months after OS, it was still significantly reduced when compared to controls, not reaching normative values.

Patterns of co-occurring birth defects among infants with hypospadias

INTRODUCTION

Hypospadias, one of the most common male genital birth defects, occurs in 1 out of every 200 male births in the United States and is increasing in prevalence globally.

OBJECTIVE

This study aimed to characterize the combinations of birth defects that co-occur with hypospadias more often than expected by chance, while accounting for the complex clustering patterns of congenital defects.

STUDY DESIGN

We analyzed cases with hypospadias and at least one additional co-occurring defect from the Texas Birth Defect Registry born between 1999 and 2014. For each combination, we calculated adjusted observed-to-expected (O/E) ratios, using Co-Occurring Defect Analysis (CODA).

RESULTS

Among 16,442 cases with hypospadias and without known syndromes, 2,084 (12.7%) had at least one additional defect. Many of the birth defect combinations within the highest adjusted O/E ratios included cardiac, musculoskeletal, and additional urogenital defects. For example, a top combination with an adjusted O/E of 139.0 included renal agenesis and dysgenesis, reduction defects of the upper limb, and other anomalies of upper limb (including shoulder girdle). High adjusted O/E ratios were also observed in combinations that included defects outside of the urogenital developmental field. For instance, the combination with the highest O/E ratio included buphthalmos, and congenital cataract and lens anomalies (adjusted O/E ratio: 192.9). Similar results were obtained when we restricted our analyses to cases with second- or third-degree hypospadias.

DISCUSSION

Many combinations in the top results were expected (e.g., multiple urogenital defects); however, some combinations with seemingly unrelated patterns of defects may suggest the presence of some etiologic mechanisms yet to be identified.

CONCLUSION

In summary, this study described patterns of co-occurring defect combinations with hypospadias that can inform further study and may provide insights for screening and diagnostic practices.

Cardiac disorders and structural brain abnormalities are commonly associated with hypospadias in children with neurodevelopmental disorders

The objective of our study was to use an established cohort of boys to investigate common patterns of malformations in those with hypospadias. We performed a retrospective review of the phenotype of participants in the Deciphering Developmental Disorders Study with neurodevelopmental delay and an 'Abnormality of the genital system'. This group was divided into two subgroups: those with hypospadias and without hypospadias. Associated phenotypes of the two subgroups were compared and analysed. Of the 166 Deciphering Developmental Disorders participants with hypospadias and neurodevelopmental delay, 47 (28%) had cardiovascular and 40 (24%) had structural brain abnormalities. The rate of cardiovascular abnormalities in those with neurodevelopmental delay and genital abnormalities other than hypospadias (N = 645) was lower at 19% (P = 0.001). In addition, structural brain malformations were higher at 24% in the hypospadias group versus 15% in the group without hypospadias (P = 0.002). The constellation of these features occured at a higher rate in the hypospadias group versus the no hypospadias group (P = 0.038). In summary, this is the first study to indicate that cardiovascular and brain abnormalities are frequently encountered in association with hypospadias in children with neurodevelopmental disorders. Not only do these associations provide insight into the underlying aetiology but also they highlight the multisystem involvement in conditions with hypospadias.