Worldwide prevalence of hypospadias

Summary

Introduction

Hypospadias is a common congenital malformation. Surgical repair and management of the long-term consequences require a substantial amount of socioeconomic resources. It is generally accepted that genetic and environmental factors play a major role in the etiology of hypospadias. There have been contradictory reports on rising hypospadias rates, and regional and ethnical differences. The exact prevalence of hypospadias is of major interest for healthcare providers, clinical medicine, and research.

Objective

To review the literature regarding the worldwide prevalence of hypospadias.

Study design

Pubmed, EMBASE and Google were systematically screened for: hypospadias, congenital malformation, anomaly, incidence, prevalence, and epidemiology. Exclusion criteria were surgical and risk-factor studies. To give an additional comprehensive overview, prevalence data were harvested from the Annual Report of the International Clearinghouse Centre for Birth Defects Surveillance and Research. Prevalence was reported as per 10,000 live births.

Results

Data were available from 1910 to 2013. The median study period was 9 years (range: 1–36 years). Approximately 90,255,200 births have been screened in all studies. The mean prevalence were: Europe 19.9 (range: 1–464), North America 34.2 (6–129.8), South America 5.2 (2.8–110), Asia 0.6–69, Africa 5.9 (1.9–110), and Australia 17.1–34.8. There were major geographical, regional, and ethnical differences, with an extreme heterogeneity of published studies. Numerous studies showed an increasing prevalence; on the other hand, there were a lot of contradictory data on the prevalence of hypospadias. The summary table shows contradictory data from the five largest international studies available.

Discussion

There was huge literature available on the prevalence of hypospadias. Most data derived from Europe and North America. Many methodological factors influenced the calculation of an accurate prevalence, and even more of the true changes in prevalence over time (no generally accepted and standardized definition of hypospadias, different monitoring systems, unclear efficiency of notification and data ascertainment, etc.). There was wide variation of prevalence according to countries and ethnicity, and there were conflicting data on the recent trends of prevalence. Moreover, there weren't any epidemiologic data available from many parts of the world.

Conclusion

True prevalence of hypospadias and trends were difficult to estimate. For the future, to be able to assess the true prevalence of hypospadias and changes in prevalence collaboration of national and international prospective registers is recommended.

Study	Year	Country	Per 10,000 live births	Time period	Trend
Bergman et al.	2015	23 European regions	18.6	2001–2010	Different trends
Chul Kim et al.	2011	South Korea	1.4–3.3	2000–2004	Increasing
Elliott et al.	2011	USA	42	1985–2006	No increase
Paulozzi	1999	International registries	10–45	1964–1997	Partial increase
Paulozzi et al.	1997	USA	17–50	1968–1993	Increasing
				1970–1993

Introduction

Hypospadias is the most common congenital malformation of the penis, and it is considered by some to be a mild form of 46XY disorders of sex development. The urethral opening occurs on the ventral side of the penis; moreover, there is hypoplasia of the ventral tissues in varying degrees, penile curvature, and excessive prepuce. It is generally accepted that genetic and environmental factors play a major role in the etiology of hypospadias [1]. Surgical repair of hypospadias and management of the long-term consequences of being born with a genital condition require socioeconomic resources. Therefore, the exact prevalence of hypospadias is of major interest for the community. Recently, the epidemiology of hypospadias and whether the prevalence is rising or stable has become part of a major debate over the potential effects of environmental factors [2]. This article systematically reviewed the literature regarding the worldwide prevalence of hypospadias and changes of prevalence over time.