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Zhao J, Chen G, Chen J, Qian L. Male refractory hypospadias with sexual reversal: a case report. J Med Case Rep 2023; 17:494. [PMID: 38012693 PMCID: PMC10683203 DOI: 10.1186/s13256-023-04230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Hypospadias is one of the most prevalent urogenital malformations in clinic. However, some hypospadias may have a more complex disorder of sex development. Usually, hypospadias in these patients is severe. Among them, the 46,XX male sex reversal syndrome is a rare disorder of sex development, and this may be the main reason for this type of hypospadias being difficult to repair. CASE PRESENTATION We present a Han nationality 19-year-old male with failure of repeated repair of hypospadias. No sperm was found on semen analysis. Lingual mucosal graft was carried out for this patient. It still did not succeed after using lingual mucosal graft repair. Karyotype analysis of this patient confirmed 46,XX karyotype. CONCLUSION Hypospadias with 46,XX male sex reversal syndrome is hard to repair. Chromosome karyotype examination in patients with hypospadias is suggested. Genetic testing is recommended. In the future, further research is needed on the pathogenesis of disease and how to treat and prevent it.
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Affiliation(s)
- Jianfeng Zhao
- Andrology Department of Traditional Chinese Medicine, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang, China
| | - Gang Chen
- The Urology Department, The Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Gongshu District, Hangzhou, 310005, Zhejiang, China
| | - Jun Chen
- The Urology Department, The Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Gongshu District, Hangzhou, 310005, Zhejiang, China
| | - Le Qian
- The Urology Department, The Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Gongshu District, Hangzhou, 310005, Zhejiang, China.
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Sembiring G, Sigumonrong Y. Efficacy of preoperative testosterone therapy in hypospadias: a systematic review and meta-analysis. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Bleeding, hematoma, edema, wound infection, and scar formation are the common problems linked with hypospadias reconstruction. Hormone treatment is recommended before surgical treatment to improve intraoperative circumstances. However, no meta-analysis has explored the effectiveness and side effects of testosterone treatment before surgery in hypospadias.
Main body of the abstract
The purpose of this paperwork is to evaluate the impact of preoperative testosterone treatment in hypospadias based on clinical data from published trials. This study searched MEDLINE, Science Direct, and the Cochrane Library without regard to year. However, only English journals were included, with a manual search using the Preferred Reporting Items for Systematic Reviews and Meta-analysis of Observational Studies in Epidemiology Guidelines supplementing the search. In this meta-analysis, five papers were considered. Two of these investigations were multicenter randomized clinical trials. Two of the studies were prospective, with a median follow-up of varying lengths. A retrospective investigation was conducted. There were 585 patients in all that took part in this trial. After surgery, the complication rate was measured in both the intervention and control groups, including meatal stenosis, fistula, glans dehiscence, scarring, reoperation rate, urethral diverticulum, fine pubic hair, and sexual precocity. The only significant difference between the intervention and control groups was that the intervention group had a decreased frequency of glans dehiscence following surgery (OR 0.40 with the 95% CI of 0.17 until 0.97).
Conclusions
This study discovered that a patient who got testosterone before surgery had a considerably decreased complication risk for glandular dehiscence. Reoperation rate, urethral-cutaneous fistula, meatal stenosis, and penile scarring in children with hypospadias, on the other hand, revealed no significant difference in the testosterone-treated group against the control group.
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Han XR, Wen X, Wang S, Hong XW, Fan SH, Zhuang J, Wang YJ, Zhang ZF, Li MQ, Hu B, Shan Q, Sun CH, Bao YX, Lin M, He T, Wu DM, Lu J, Zheng YL. Associations of TGFBR1 and TGFBR2 gene polymorphisms with the risk of hypospadias: a case-control study in a Chinese population. Biosci Rep 2017; 37:BSR20170713. [PMID: 28894026 PMCID: PMC5629700 DOI: 10.1042/bsr20170713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 02/06/2023] Open
Abstract
This case-control study investigated the association of transforming growth factor-β (TGF-β) receptor type I and II (TGFBR1 and TGFBR2) gene polymorphisms with the risk of hypospadias in a Chinese population. One hundred and sixty two patients suffering from hypospadias were enrolled as case group and 165 children who underwent circumcision were recruited as control group. Single nucleotide polymorphisms (SNPs) in TGFBR1 and TGFBR2 genes were selected on the basis of genetic data obtained from HapMap. PCR-restriction fragment length polymorphism (PCR-RFLP) was performed to identify TGFBR1 and TGFBR2 gene polymorphisms and analyze genotype distribution and allele frequency. Logistic regression analysis was conducted to estimate the risk factors for hypospadias. No significant difference was found concerning the genotype and allele frequencies of TGFBR1 rs4743325 polymorphism between the case and control groups. However, genotype and allele frequencies of TGFBR2 rs6785358 in the case group were significantly different in contrast with those in the control group. Patients carrying the G allele of TGFBR2 rs6785358 polymorphism exhibited a higher risk of hypospadias compared with the patients carrying the A allele (P<0.05). The TGFBR2 rs6785358 genotype was found to be significantly related to abnormal pregnancy and preterm birth (both P<0.05). The frequency of TGFBR2 rs6785358 GG genotype exhibited significant differences amongst patients suffering from four different pathological types of hypospadias. Logistic regression analysis revealed that preterm birth, abnormal pregnancy, and TGFBR2 rs6785358 were the independent risk factors for hypospadias. Our study provides evidence that TGFBR2 rs6785358 polymorphism might be associated with the risk of hypospadias.
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Affiliation(s)
- Xin-Rui Han
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Xin Wen
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Shan Wang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Xiao-Wu Hong
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, P.R. China
| | - Shao-Hua Fan
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Juan Zhuang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
- Jiangsu Key Laboratory for Eco-Agricultural Biotechnology around Hongze Lake, School of Life Sciences, Huaiyin Normal University, Huaian 223300, P.R. China
| | - Yong-Jian Wang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Zi-Feng Zhang
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Meng-Qiu Li
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Bin Hu
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Qun Shan
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Chun-Hui Sun
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Ya-Xing Bao
- Department of Orthopedics, The Affiliated Municipal Hospital of Xuzhou Medical University, Xuzhou 221009, P.R. China
| | - Meng Lin
- Department of Urology Surgery, Peking Union Medical College Hospital, Beijing 100730, P.R. China
| | - Tan He
- Department of Urology Surgery, Peking Union Medical College Hospital, Beijing 100730, P.R. China
| | - Dong-Mei Wu
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Jun Lu
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
| | - Yuan-Lin Zheng
- Key Laboratory for Biotechnology on Medicinal Plants of Jiangsu Province, School of Life Science, Jiangsu Normal University, Xuzhou 221116, P.R. China
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Abstract
Hypospadias is the most common congenital malformation of the male external genitalia. After the heart and circulatory system, it is the second most common developmental disorder in males. It is due to a midline fusion defect of the male urethra, which results in a misplaced urethral meatus. Hypospadias may be distal, medial and proximal. It may occur as an isolated defect or it may develop together with other genital disorders (retention of testes in one or both sides, microphallus, bifid scrotum) or with malformation of other organs. In some cases syndromic forms may also occur. Genetic factors play a crucial role in the occurrence of early developmental defect, but endocrine and environmental factors may also be important in the aetiology of hypospadias. It may be associated with various sex and autosomal chromosomal abnormalities. Monogenic and chromosomal causes of hypospadias accounts for about in 30% of all cases, while genetic factors remain unknown in 70% of cases. The authors summarize the development of the male external genitalia, the prevalence and possible causes of hypospadias. They propose that better understanding of the pathogenesis of the disease may contribute to the prevention and decreased prevalence of the disease.
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Affiliation(s)
- László Ságodi
- Miskolci Egyetem, Egészségügyi Kar Preventív Egészségtudományi Tanszék Miskolc Egyetemváros u. 1. 3515
| | - Akos Kiss
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Gyermeksebészeti Osztály Miskolc
| | - Emőke Kiss-Tóth
- Miskolci Egyetem, Egészségügyi Kar Preventív Egészségtudományi Tanszék Miskolc Egyetemváros u. 1. 3515
| | - László Barkai
- Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Tanszék Miskolc Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Csecsemő- és Gyermekosztály Miskolc Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Gyermekegészségügyi Továbbképző Intézet Miskolc
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Ságodi L, Kiss Á, Kiss-Tóth E, Barkai L. [Questions and dilemmas in the management of hypospadias]. Orv Hetil 2014; 155:1097-101. [PMID: 25002312 DOI: 10.1556/oh.2014.29907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hypospadias is the second most common congenital malformation in males. Etiology remains unknown in about 70% of the cases. Distal hypospadias is considered not only developmental abnormality of the urethra in males, but it may also constitute a mild form of sexual development disorder in 46,XY males. Most urologists and endocrinologists consider that it is necessary to perform a detailed investigation of children presenting with proximal hypospadias associated with a small phallus or poorly developed scrotum and undescended testes. Currently, there is no generally accepted recommendation for the preoperative evaluation of hypospadias and, therefore, masculinizing surgery without preoperative evaluation is performed in these children. The authors summarize the international literature data and their own experience for the assessment and management of hypospadias concerning questions and problems related to preoperative investigation, masculinizing surgery and additional surgery. A detailed algorithm is presented for preoperative evaluation of both proximal and distal hypospadias.
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Affiliation(s)
- László Ságodi
- Miskolci Egyetem, Egészségügyi Kar Preventív Egészségtudományi Tanszék Miskolc Egyetemváros u. 1. 3515
| | - Ákos Kiss
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Gyermeksebészeti Osztály Miskolc
| | - Emőke Kiss-Tóth
- Miskolci Egyetem, Egészségügyi Kar Preventív Egészségtudományi Tanszék Miskolc Egyetemváros u. 1. 3515
| | - László Barkai
- Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Tanszék Miskolc Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Csecsemő- és Gyermekosztály Miskolc Debreceni Egyetem Klinikai Központ Gyermekegészségügyi Továbbképző Intézet Miskolc
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Ságodi L, Jakab J, Kiss Á, Ladányi E, Balogh E, Ujfalusi A, Papp J, Megyeri T, Kovács J. Dysgenetic male pseudohermaphroditism. Orv Hetil 2012; 153:303-7. [DOI: 10.1556/oh.2012.29303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors report a case of a dysgenetic male pseudohermaphroditism with a 45,X/46,XY karyotype in a mosaic form, which was diagnosed in an infant. The one-week-old infant was evaluated because of proximal hypospadias and retention of the right testis. The results of hormonal tests were the followings: serum FSH 5.2 mU/ml; LH: 2.0 mU/ml; testosterone: 144.3 ng/dl; androstendione: 0.42 µg/l; 17-hydroxyprogesterone: 1.12 ng/ml. Chromosomal analysis revealed 45,X/46,XY karyotype. Fluorescent in vitro hybridization showed that 51% of the lymphocytes had the Y chromosome and the SRY gene. Analysis of the SRY showed no deletion in the AZF a,b,c regions. Pelvic magnetic resonance imaging indicated the presence of vagina between the bladder and the rectum, and it showed a mass measuring 15×8 mm in the right inguinal canal as well as an oval gonadal mass with a size of 13×7 mm in the left scrotum. During surgical intervention, performed at the age of one, the right gonad was removed and biopsy of the scrotal testis was performed. Histological examination revealed dysgenetic testis in both sides. The authors emphasize the necessity of cytogenetic and endocrinological investigations of newborns with perineoscrotal hypospadia and bilateral or unilateral maldescent testes immediately after birth. Surgical removal of the dysgenetic testicular tissue located in the abdominal cavity and its histological evaluation provides separation of mixed gonadal dysgenesis, dysgenetic male pseudohermaphroditism, bilateral gonadal dysgenesis and ovotestis in the 45,X/46,XY mosaic cases. An accurate evaluation is necessary for a correct sex assignment and for surgical intervention to prevent neoplastic degeneration of the dysgenetic gonad. Orv. Hetil., 2012, 153, 303–307.
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Affiliation(s)
- László Ságodi
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház III. Csecsemő- és Gyermekosztály Miskolc Pf. 188 3501
- Miskolci Egyetem, Egészségügyi Kar Védőnői Tanszék Miskolc
| | - Janka Jakab
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Koraszülött- és Újszülöttpatológiai Osztály Miskolc
| | - Ákos Kiss
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Gyermeksebészeti Osztály Miskolc
| | - Erzsébet Ladányi
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Gyermekradiológiai Osztály Miskolc
| | - Erzsébet Balogh
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Gyermekgyógyászati Klinika, Klinikai Genetikai Központ Debrecen
| | - Anikó Ujfalusi
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Gyermekgyógyászati Klinika, Klinikai Genetikai Központ Debrecen
| | - Judit Papp
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Koraszülött- és Újszülöttpatológiai Osztály Miskolc
| | - Tímea Megyeri
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Koraszülött- és Újszülöttpatológiai Osztály Miskolc
| | - Judit Kovács
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Patológiai Osztály Miskolc
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