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Rise in Prevalence of Hypospadias
... Though hypospadias is prevalent across the globe, recent reports have shown that there has been an increase in its incidence in the western world over the last decade. [1]The 1996 Committee for the American Academy of Paediatrics Section on Urology reviewed psychological factors, anaesthetic considerations, and technical aspects of repair before recommending surgery be performed between 6 and 12 months, assuming the surgeon, anaesthesiologist, and facility were experienced in care of infants. [2] Though various postoperative scoring systems like HOSE, PPS have been described in literature so as to allow more objective assessment of the outcome of the repair, there is paucity of such objective scoring system in preoperative assessment. ...
... It is often associated with incomplete development of the foreskin and abnormal penile curvature 2,3 . It is a common congenital malformation and the prevalence is reported to be increasing, although it has a large geographical variation ranging from 2 to 43 cases per 10,000 live births 4,5 . The incidence is reported to be one in every 300 male live births 2 . ...
Background: Hypospadias a very common condition in the children and the incidence is increasing. Here we present our experience of managing hypospadias patients over the last five years. Materials and methods: It was a retrospective study from 2014 to 2018 in the Department of Pediatric Surgery, Chattogram Medical College Hospital. Records of all hypospadias patients were analyzed and type of hypospadias, age at repair, type of repair and admission with complication of hypospadias were recorded. Results: A total of 492 boys were admitted with the diagnosis of hypospadias and 272 boys underwent hypospadias surgery. Distal penile hypospadias (148 patients, 30%) was the commonest variety followed by coronal hypospadias (144 patients, 29%). Age at surgery ranged from 6 months to 19 years with a mean age of 7±4 years. General anesthesia was given in 133 patients (64.7%) spinal anesthesia in 93 patients (31.8%) local anesthesia in 7 patients (2.4%) and caudal block in 3 patients (1%). Urethro-cutaneous fistula, failed urethroplasty and meatal stenosis are the admissions with hypospadias complications. Conclusion: Hypospadias is still common with substantial number of complications. Health education is necessary to reduce age at surgery. JCMCTA 2020 ; 31 (1) : 38-41
... However, the results suggest that the ratio of minor to severe cases is decreasing, not increasing, as one would expect if the change in hypospadias rates was secondary to more frequent reporting of minor forms. (5) A small percentage of severe hypospadias can be attributed to genetic syndromes or defects involving the androgen receptor (6) . Assisted reproductive techniques have also been associated with an increased risk for hypospadias; however, the etiology in the majority of cases of hypospadias remains unknown (7) . ...
Hypospadias is a relatively common congenital anomaly of the penis that arises in 2 to 8 of 1000 live births, often as an isolated anomaly. This anomaly is repaired surgically in the first year of life to improve the cosmetic appearance and establish a glanular position of the urinary meatus for voiding and deposition of semen later in life. The aim of this study is to evaluate the effectiveness of HCG hormonal manipulation in inducing penile growth in hypospadias boys before surgical repair , and the pattern of this growth and response , in addition to that this thesis try to add more knowledge to the etiology and pathogensis of one of these relatively common urogenital disorder. Patients and methods :-This small series thesis included 16 boys with an age ranged from 3-48 ms who had proximal and penoscrotal hypospadias with sever cordea .All boys received a full course of HCG treatment using the standard WHO protocol of HCG therapy in pediatric age group. The degree and rate of response to HCG therapy together with the pattern of penile growth have been measured and evaluated before and one week after HCG therapy using the student T-test for statistical analysis. Results :-At the end of HCG treatment penile growth has been achieved in all boys. The cordee decreased and penile length increased in all cases. The mean stretched penile length was changed from 18.68 pre HCG to 31.97 post treatment (P value < 0.001). The average penile length was nearly doubled after HCG treatment with an increase of 40% to 180% (mean 83%, P value < 0.001)What was very interesting and major finding that emerge during this study , is that the penile response and growth to HCG treatment was not universal over the whole shaft of the penis, with by far most of increment in penile length occurred proximal to urethral meatus and the percentage of Kufa Med.Journal 2012.VOL.15.No.1 379 penile growth was 262% (P value < 0.001) proximal to meatus , while it was only 24% not significant (P value > 0.001) distal to it. This disproportional penile growth causing the meatus to advance distally in all cases with a mean distal migration of urethral meatus was 9.75 mm (P value < 0.001). Conclusion :-HCG treatment in hypospadias was very effective in achieving sufficient penile growth that might facilitate the surgical outcome, the other finding is that hypospadias even the sever one is not at a fixed stage or degree, but it can easily be manipulated by hormonal treatment in addition to that, this study suggest that post natal response of hyposadias penis to HCG might provide a mirror that reflect its intra natal response during organogenesis and embryogenesis, and this thesis might provide a different insight toward the pathogenesis of hypospadias-chordea complex by diverting more attention and focusing toward a localized endocrinopathy that affect the tissue responsiveness to androgen. Introduction Hyppospadias is a relatively common congenital anomaly of the penis that arises in 2 to 8 of 1000 live births, often as an isolated anomaly (1) The urinary meatus is positioned on the ventral surface of the penis. There is an incomplete foreskin, ''a dorsal hood,'' and varying degrees of ventral curvature .This anomaly is repaired surgically in the first year of life to improve the cosmetic appearance and establish a glanular position of the urinary meatus for voiding and deposition of semen later in life (1) .Hyppospadias affect approximately one in 250 live male births (2, 3). recent reports suggest an increasing incidence of hypospadia (4) The rising trend may simply reflect a more frequent or early diagnosis of mild forms of hypospadias over time or an increasing tendency to report the disorder to congenital anomaly registries. However, the results suggest that the ratio of minor to severe cases is decreasing, not increasing, as one would expect if the change in hypospadias rates was secondary to more frequent reporting of minor forms. (5) A small percentage of severe hypospadias can be attributed to genetic syndromes or defects involving the androgen receptor (6). Assisted reproductive techniques have also been associated with an increased risk for hypospadias; however, the etiology in the majority of cases of hypospadias remains unknown (7) .
... Male external genitalia development is an androgendependent process, and it has been hypothesized that problems in the endogenous hormone production and action, or exposure to external estrogenic or anti-androgenic acting agents might result in hypospadias [20]. In the experimental setting, exogenous endocrine-disruptors have the potential to induce hypospadias, but it is unclear whether human exposure is high enough to exert this effect. ...
... Male external genitalia development is an androgendependent process, and it has been hypothesized that problems in the endogenous hormone production and action, or exposure to external estrogenic or anti-androgenic acting agents might result in hypospadias [20]. In the experimental setting, exogenous endocrine-disruptors have the potential to induce hypospadias, but it is unclear whether human exposure is high enough to exert this effect. ...
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.
... Pediatrik anestezi alanındaki gelişmeler ve cerrahi tekniklerin ilerlemesi sonucunda hipospadias cerrahisi hayatın ilk dönemlerinde yapılabilmektedir. Amerikan Pediatri Akademisi hipospadias onarımı için en uygun zamanın 6-12 aylar olduğu belirtmiştir (9). Hensle ve ark. ...
Aim: Hypospadias is one of the most common malformations in the male genital tract and distal hypospadias is the most frequent type. In this study, we aimed to retrospectively analyze medical records of patients who have undergone distal hypospadias surgery between April 2011 and April 2013 in a state hospital.
Methods: We retrospectively evaluated hospital records of 48 patients who have been operated for distal hypospadias between April 2011 and April 2013. All patients were operated by a single surgeon (AŞ). Patient age, type of hypospadias, the presence of chordee and history of circumcision were evaluated. In addition, duration of surgery, duration of catheterization, length of hospital stay, and short-term and long-term complications were recorded.
Results: The mean age of the patients was 7.38±3.77years. Subcoronal hypospadias was the most frequent type and eight of patients had chordee. A total of 42 patients underwent tubularized incised plate urethroplasty (TIPU) and six patients underwent meatal advancement and glanduloplasty (MAGPI). The mean duration of surgery was 83.41±25.65 minutes. None of the patients had a short-term complication; meatus stenosis developed during long-term follow-up in three patients who were treated by dilatation. Additionally, TIPU was performed in three patients in whom fistulas developed.
Conclusion: We aimed to demonstrate that distal hypospadias surgery could be performed with low complication and high success rates in state hospitals by surgeons who receive training in hypospadias surgery. (The Medical Bulletin of Haseki 2014; 52: 195-8)
... G enital malformations are associated with a large spectrum of disorders and can be broadly classified into XX masculinisation and XY undermasculinisation. Whereas most cases of XX masculinisation are due to congenital adrenal hyperplasia (approximate occurrence rate of 1 in 12 000 live female births), XY undermasculinisation is due to a more heterogeneous group of conditions. 1 As hypospadias is associated with a single identifiable genital defect, its prevalence has been widely studied and some recent studies suggest that its prevalence is rising. [2][3][4][5] The aim of this study was to explore temporal, geographical, and socioeconomic trends in the occurrence of genital anomalies in a geographically defined part of the United Kingdom using a group of databases that collect standardised information on all births. ...
Background: Considerable debate exists on the epidemiology of genital anomalies. Methods: All genital anomalies, excluding undescended testes, were identified from neonatal returns, stillbirth and infant death survey records, and returns relating to hospital admissions and linked to form infant profiles on a cohort of singleton births between 1988 and 1997 with follow up for a minimum of three years. Findings: The mean genital anomaly prevalence rate in Scotland was calculated at 4.6 per 1000 births varying from 4.0 per 1000 births in 1988 to 5.9 per 1000 births in 1996. However, there was no evidence of a clear trend to an increasing prevalence of hypospadias, which constituted 73% of the anomalies studied. Logistic regression analysis of the data also showed this rate to be independently associated with being relatively small for gestational age (odds ratio (OR) 1.43, p < 0.001) and increasing maternal age (OR 1.2, p < 0.05). Infants born in deprived areas, as judged by the Carstairs deprivation score, were least likely to have a genital anomaly (OR 0.73, p < 0.01). Interpretation: A new linked register of congenital genital anomalies in Scotland suggests that over a decade, the birth prevalence of genital anomalies has changed little. The associations between genital anomalies, maternal age, and socioeconomic deprivation require further study.
... In humans, extra nipples are called supernumerary nipples or polythelia. We hypothesized that in-utero exposure to the androgen antagonist DDE could be related to the frequency of cryptorchidism, hypospadias, and polythelia among boys (9). To test this hypothesis, we studied a population with relatively high serum DDE levels: persons born in the United States in the early 1960s. ...
1,1-Dichloro-2,2-bis(p-chlorophenyl))ethylene (p,p'-DDE) is a metabolite of the insecticide 2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane (DDT) and is a ubiquitous environmental contaminant. Nearly everyone in the United States has a detectable serum level of DDE. DDE was recently found to inhibit binding of androgen to its receptor and to block androgen action in rodents. Normal development of male genitalia in mammals depends on androgen action. The authors used stored serum samples to examine the relation between maternal DDE levels during pregnancy and adjusted odds of cryptorchidism (n = 219), hypospadias (n = 199), and polythelia (extra nipples) (n = 167) among male offspring, using a nested case-control design with one control group (n = 552). Subjects were selected from the Collaborative Perinatal Project, a US birth cohort study begun in 1959-1966, when DDE levels were much higher than they are at present. Compared with boys whose mother's recovery-adjusted serum DDE level was less than 21.4 μg/liter, boys with maternal levels greater than or equal to 85.6 μg/liter had adjusted odds ratios of 1.3 (95% confidence interval (Cl): 0.7, 2.4) for cryptorchidism, 1.2 (95% Cl: 0.6, 2.4) for hypospadias, and 1.9 (95% Cl: 0.9, 4.0) for polythelia. For cryptorchidism and polythelia, the results were consistent with a modest-to-moderate association, but in no instance was the estimate very precise. The results were inconclusive.
... Hypospadias is one of the most common urogenital anomalies with the prevalence rate of approximately 0.4 to 8.2 per 1000 live births [1,2]. Recent studies have shown a worldwide increasing incidence of hypospadias [2][3][4]. ...
To retrospectively identify the individual risk factors for the urethrocutaneous fistula (UCF) in pediatric patients after hypospadias repair (HR) with onlay island flap urethroplasty.
A total of 167 patients who underwent primary HR at Nanjing Medical University Affiliated Children Hospital from January 2009 to December 2012 were enrolled. Clinical data including the patient' age at HR, hypospadias type and urethral defect length were documented.
Among 167 patients, 12.6% patients (n = 21) developed UCF after HR. Postoperative UCF occurred in 3.9% (3/76) cases at age of 0-2 years, 14.3% (9/63) at 2-4 years, 20.0% (2/10) at 4-6 years and 38.9% (7/18) at 6-12 years. The incidences of UCF were 12.0% (3/25), 11.4% (5/132) and 30.0% (3/10) for distal, middle and proximal types of hypospadias. As to the urethral defect length, the incidences of UCF were 8.2% (5/61) in patients with a length of ≤ 2 cm, 12.8% (9/70) in 2-3 cm, 22.6% (7/31) in 3-4 cm and 0% (0/5) in above 4 cm. Older age at HR was significantly associated with the high incidence of UCF formation (P = 0.004), while the hypospadias type and urethral defect length did not affect it (P = 0.264 and P = 0.312, respectively).
The patient' age at HR was a risk factor for the UCF formation after HR, and treatment of HR within two years old might be with the least incidence of UCF.
... Indeed, based on current research, human fertility in many industrial and non-industrial countries is declining, not increasing, in contradiction to Ehrlich's claims. Reasons for this decline include a dramatic increase in androgenic pathologies such as declining male semen quality, as well as a rise in testicular cancer, undescended testis and hypospadias (Bergström et al., 1996;Dolk, 1998;Irvine, Cawood, Richardson, MacDonald, & Aitken, 1996;De Mouzon, Thonneau, Spira, & Multigner, 1996;Jensen et al., 2002;Jouannet, Wang, Eustache, Kold-Jensen, & Auger, 2001;Menchini-Fabris, Rossi, Palego, Simi, & Turchi, 1996;Skakkebaek, Rajpert-De Meyts, & Main, 2001). There are speculative multiple reasons for this androgenic malaise (i.e. ...
At present, various national populations are now at different stages of the demographic transition. This transition may have far-ranging consequences for future humans. With the envisaged artificial support for human life, the significance of these non-metabolic processes may increase. Though the Earth is a thermodynamically open system receiving energy from the universe, the amount of energy flow is limited and the way its flow is structured on the globe restricts human development. Therefore, the future relationship between human population and the Earth may be constrained by a number of conditions; it may no longer be a simple conquest of the world by technology-wielding humans. Human cultures are still adapted to a world of high mortality, high fertility and little mass migration, where the structure and function of the human body was automatically adjusted by natural selection requiring medical intervention only rarely in cases of acute diseases or injuries. Moreover, human population may also continue to increase its “genetic load”, leading to a further decline in population fitness. This article will provide possible future scenarios for humankind from both evolutionary and cultural perspectives which may reduce long-term human fitness.
... The same increase of hypospadias cases has also been indicated in some European countries including Norway, Denmark, Italy and France (Paulozzi, 1999). The reason for the rising incidence remains uncertain but the high frequency of endocrine disruption in industrialized countries is proposed as a possible explanation for this increase (Dolk et al, 1998;Wakefield et al, 2001). ...
... Hypospadias occurs in approximately one of every 150-300 male births and may arise more frequently in developing countries. 10,11 While not life-threatening and concealed by normal clothing, the potential consequences of uncorrected hypospadias include social stigmatization and urinary or sexual dysfunction. 12 The most common complication of hypospadias repair is urethrocutaneous fistula, which in LMICs occur at rates of 10-22% in patients with mixed severity and a range of follow-up periods. ...
Purpose:
This study was designed with three objectives: to assess perceptions of untreated hypospadias and quality of life in culturally disparate low- or middle-income countries (LMICs), to highlight the demographic and care differences of patient groups treated for hypospadias in the surgical workshop context, and to evaluate the long-term outcomes achieved by these workshop groups.
Materials and Methods:
Family member perceptions of hypospadias, perioperative process measures and urethrocutaneous fistula rates were compared between patients in Vietnam and Senegal treated for hypospadias through training workshops by local surgeons and pediatric urologists from the United States from 2009-2012 (n=60), with 42% of patients having previous repair attempts.
Results:
Over 90% of respondents surveyed felt that untreated hypospadias would affect their child’s future at least to some degree. Patient cohorts between the two sites differed from each other and published high-income country (HIC) cohorts with respect to age, weight-by-age, and frequency of reoperation. Telephone-based outcomes assessment achieved an 80% recall rate. Urethrocutaneous fistula was reported in 39% and 47% of patients in Vietnam and Senegal, respectively.
Conclusions:
Family members perceived that the social consequences of untreated hypospadias would be severe. Relative to patient cohorts reported in HIC practices, our patients were older, presented with more severe defects, required more reoperations and were often undernourished. Urethrocutaneous fistula rates were higher in both LMIC cohorts relative to published HIC cohorts. Our study argues that outcomes measurement is a feasible and essential component of ethical international health care delivery and improvement.
... Hypospadias is one of the most common birth defects and its prevalence is rising. 1,2 Numerous types of surgical techniques have been described over the years and are still used by different surgeons. The main goal of any hypospadias repair is to reach and maintain a normal urinary and reproductive function with good cosmetic result. ...
We evaluate the influence of surgeon experience and other clinical factors on the success of primary hypospadias repair, using the tubularized incised plate urethroplasty (TIPU) technique.
We retrospectively reviewed pediatric cases of primary hypospadias repair performed by a single pediatric urologist (soon after his fellowship training) using TIPU between July 2002 and January 2011. The surgical techniques (including the fact that the procedure was an outpatient one) were the same for each patient. The overall complication rate (CR) was analyzed for the following factors: patient age, use of a stent, meatal position, and surgeon experience. All significant covariates on univariate analysis or with a clinical relevance were entered into a multivariable logistic regression model. A non-linear model was created to estimate the change in the CR over the years.
Pediatric patients (median age 1.4 years old) presenting with distal (n = 251), midshaft (n = 22) or proximal (n = 30) hypospadias and with a minimum 6-week follow-up (median 13 months) were included. Most patients (87%) had a urethral stent postoperatively (mean duration 9.8 days). In total, 96 patients had 133 complications: 27 meatal stenosis, 25 meatal coronal migrations, 22 urethrocutaneous fistulas and 59 other complications. Of these, 53 patients underwent a second operation. On multivariate analysis, the only factor increasing the CR was a non-distal meatus. The non-linear model demonstrated a significant learning curve with a decreasing CR over the years. The limitations of this study are its retrospective nature and lack of long-term follow-up.
When using TIPU, the CR significantly increases as the meatal position gets more proximal; the learning curve stabilizes after about 50 to 75 cases.
environmental management in DRC
Hypospadias is one of the most common congenital anomalies referred to a Pediatric Urologist. Over the last 25 years, there has been a significant increase in the reported incidence. Numerous techniques have been described in the quest for the perfect penis, but there is no consensus in the severity of this pathology and possible treatments. Hormone therapy for this condition is still a controversial issue and the lack of good quality outcome data on long term follow up make decision making even more difficult. The aim of this chapter is to focus on the practical aspects of diagnosis and an evidence-based approach to the management.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
Reproduction is essential to the continuation and evolution of life on this planet and is therefore a centrally important process in the conservation of wildlife. However, reproductive mechanisms are well understood in only a handful of vertebrate species, mostly domestic livestock and laboratory animals. This means that attempts to develop and implement management policies for wildlife conservation, and especially for endangered species that, by definition, are difficult to study, are often based on poor data or no data at all. In Reproductive Science and Integrated Conservation leading authorities provide glimpses of reproductive diversity in fishes, amphibia, reptiles, birds and mammals. Conservation plans are founded on the assumption that reproduction will be successful, but what if it fails? This book reviews the many factors that influence reproduction, including genetics, behaviour and nutrition, and experts assess the potential conservation relevance of the recent rapid advances in reproductive technology and medicine.
The effect of exposure to background levels of dioxins and PCB s transplacentally and through breast-feeding on healthy new-born babies after an optimal pregnancy were studied in the Netherlands.
Negative effects were found on the development of the thyroid hormone metabolism, psychomotor development, behaviour and the immune system. Most of these effects were related to transplacental exposure. However, negative effects on the immune system and behaviour were related to current levels of PCBs measured in the blood of the child at the age of forty-two months. These findings can be extrapolated to areas in Europe with the same background levels.
Aim of the study was to evaluate the results of tubularized incised plate (TIP) urethroplasty in distal and mid penile hypospadias repair.
In this retrospective study, we analyzed the medical records of 195 boys (mean age: 2.1 years, range: 0.5-13 years) with distal penile (n=170) or mid penile hypospadias (n=25), who underwent TIP urethroplasty between January 2003 and December 2007 in our institution. The details of the procedure are described and the postoperative outcomes and treatment of complications are reviewed. Patients were followed up for a mean of 36 months (range: 6-60).
Mean duration of surgery was 57.9 (range: 40-100) minutes. Mean duration of postoperative hospital stay was 10.5 (range: 7-12) days. The overall complication rate was 16.9 % with 12.6% patients requiring specific intervention. The overall rate of fistula occurrence was 7.2%; the incidence of meatal stenosis was 5.6% and of wound dehiscence was 2.7%. The difference between the incidence of complications after repair of mid or distal penile hypospadias was found to be statistically insignificant (p<0.05). Our complication rate decreased significantly from 13.8% during the first 3 years to 3% during the last 2 years. Good cosmetic results were obtained in 92.3% of cases. The functional result, as judged by the urinary stream, was good in 93.8%.
Tubularized incised plate urethroplasty is a simple, quick, single-stage procedure suitable both for mid and distal penile hypospadias repair. It provides an excellent functional neo-urethra, a cosmetically normal looking glans and meatus and is associated with very few complications.
Most estimates of prevalence of hypospadias in Europe and the USA range up to a maximum of 3 per 1,000 births, with two-thirds to three-quarters of cases being glanular or coronal (Table 3.1).
Abnormalities of the external genitalia span the spectrum from subtle findings of limited clinical significance to profound anomalies that call into question such essential questions as sex determination. In addition, missing a diagnosis of congenital adrenal hyperplasia in a newborn female child with virilized external genitalia can result in near-term mortality, whereas a large inguinal hernia could present rapidly with incarceration if undetected. To that end, this article seeks to present a survey of commonly encountered genital abnormalities while highlighting those scenarios that require multidisciplinary interventions.
Hypospadias are diagnosed at birth. Counseling of the parents should be performed in detail. Isolated hypospadias has to be differentiated from disorders of sexual development which are mostly associated with cryptorchidism and micropenis. The operation is timed around the first birthday. Preoperative hormonal treatment should be reserved for infants with a small glans penis or for repeat surgery. The most popular method in distal hypospadias repair is preservation of the urethral plate and tubularization with or without midline incision. In proximal cases with severe curvature a two-stage procedure may be preferable. Dripping-stent urinary drainage into a double diaper is the best method in infants. The complication rate after primary distal repair is reported in the literature to be less than 10% and after staged procedures in proximal hypospadias over 25%.
Permanent grassland of a typical Alpine region in Austria (Styria, 700 m above sea level, 1100 mm precipitation) was cut either 2, 3 or 4 times per year, conserved as barn-dried hay and fed to dairy cows at three concentrate levels [zero, concentrate according to requirements or 25% of dry matter (DM) intake concentrate]. Fertilisation levels were 32 m3 slurry with or without 100 kg N ha−1 mineral N. Because of lower DM yield (8.65, 8.05, 6.51 t ha−1) and higher forage intake (10.4, 13.2 and 15.3 kg DM) the potential stocking rate decreased with increasing cutting frequency. Milk yield and N excretion per cow increased with increasing cutting frequency. When milk yield and N excretion were related to the forage area there was only a small influence of cutting frequency at the low level of concentrate. When the forage was supplemented with concentrate according to requirements, both milk yield and N excretion per ha decreased with increasing cutting frequency. Additional fertilisation of 100 kg mineral N increased the amount of slurry from 37.5 to 41.4 m3 ha−1 forage and excretion of N from 149 to 160 kg ha−1 forage.
During the past decades, we have witnessed a remarkable decline in fertility rates (number of births per 1000 women of reproductive age) in the industrialized world. It seems beyond doubt that the enormous social changes of our societies play the major role in this decline, but we argue that reduced fecundity (the ability to conceive) in the population may be a contributing factor. The time taken to conceive (Time To Pregnancy, TTP) has proven a valuable tool in measuring fecundity of a couple, but few studies have attempted to study trends in TTP. Another proposed marker is the spontaneous dizygotic twinning rate, which has declined until the 80s where the use of ovulation-inducing agents introduced increase. Fecundity may be affected both by female and male factors. Semen quality may have deteriorated considerably during the past 50 years and large geographical differences exist. Not many studies among unselected men from the general population exist, but when studying semen quality in an unselected population of young Danish men we found an alarmingly low semen quality. In addition, other biological markers of male fecundity may have changed in prevalence—hypospadias, cryptorchidism and testicular cancer. Changes in ovarian function (biological female factors) may also contribute to a change in the fecundity, although the literature in this field is sparser. We lack information on the roles of modern lifestyle and food contaminants (including endocrine disrupters) on reproductive function in males, as well as in females. It is therefore important that we, even though it is time consuming and costly, continue to monitor semen quality and begin to monitor fecundity, including trends in waiting time to pregnancy.
Male reproductive health has deteriorated in many countries during the last few decades. In the 1990s, declining semen quality has been reported from Belgium, Denmark, France, and Great Britain. The incidence of testicular cancer has increased during the same time incidences of hypospadias and cryptorchidism also appear to be increasing. Similar reproductive problems occur in many wildlife species. There are marked geographic differences in the prevalence of male reproductive disorders. While the reasons for these differences are currently unknown, both clinical and laboratory research suggest that the adverse changes may be inter-related and have a common origin in fetal life or childhood. Exposure of the male fetus to supranormal levels of estrogens, such as diethlylstilbestrol, can result in the above-mentioned reproductive defects. The growing number of reports demonstrating that common environmental contaminants and natural factors possess estrogenic activity presents the working hypothesis that the adverse trends in male reproductive health may be, at least in part, associated with exposure to estrogenic or other hormonally active (e.g., antiandrogenic) environmental chemicals during fetal and childhood development. An extensive research program is needed to understand the extent of the problem, its underlying etiology, and the development of a strategy for prevention and intervention.
Epidemiological and genetic variables in hypospadias were analysed during the years 1978 to 1983 in a case control study of congenital malformations in the Emilia Romagna region of northern Italy. During the observation period, in a sample of 41 078 male newborns, 168 had hypospadias giving a prevalence at birth of 4.1 in 1000 males. Hypospadias was divided into three types: type I or mild (75.0%); type II or moderate (21.4%); and type III or severe (3.6%). Coexisting malformations were found in 8.9% of cases. The heritability coefficient was 0.669. Maternal risk factors correlated with hypospadias were found to be early age at menarche, threatened abortion, and exposure to progestins. Low birth weight and shorter gestation were also correlated with hypospadias.
To determine if first-trimester exposure to sex hormones, and oral contraceptives (OCs) specifically, is associated with an increased risk of external fetal genital malformations.
MEDLINE and Science Citation Index data bases were searched for the years 1966-1992 for relevant English-language articles on first-trimester sex-hormone exposure and fetal genital changes.
One hundred eighty-six articles were identified initially. Inclusion criteria were cohort or case-control studies, first-trimester sex-hormone exposure, and live infants or full-term stillborn infants with external genital malformations. Exclusion criteria were diethylstilbestrol exposure, spontaneous abortions, and teratogen exposure.
The Methods section of each study was reviewed independently by two authors and two outside reviewers, using the above criteria. Fourteen studies, seven cohort and seven case-control, involving 65,567 women, met the criteria for meta-analysis. Extracted data were entered into 2 x 2 tables. The overall summary odds ratio (OR) was 1.09 (95% confidence interval [CI] 0.90-1.32); subanalysis of OC exposure identified an OR of 0.98 (95% CI 0.24-3.94).
There was no association between first-trimester exposure to sex hormones generally (or to OCs specifically) and external genital malformations. Thus, women exposed to sex hormones after conception may be assured there is no increased risk of fetal sexual malformation.
The incidence of disorders of development of the male reproductive tract has more than doubled in the past 30-50 years while sperm counts have declined by about half. Similar abnormalities occur in the sons of women exposed to diethylstilbestrol (DES) during pregnancy and can be induced in animals by brief exposure to exogenous oestrogen/DES during pregnancy. We argue that the increasing incidence of reproductive abnormalities in the human male may be related to increased oestrogen exposure in utero, and identify mechanisms by which this exposure could occur.
Hypospadias is a common congenital anomaly, the cause of which is unknown. Unexplained increases in the rates of hypospadias occurred in five European countries in the 1970s and 1980s. We examined data from two birth defects surveillance systems in the United States for evidence of similar trends.
The Metropolitan Atlanta Congenital Defects Program (MACDP) provided birth prevalence rates from 1968 to 1993. The nationwide Birth Defects Monitoring Program (BDMP) provided rates from 1970 to 1993. MACDP data are population-based and could be categorized by the severity of the hypospadias. BDMP data allowed analysis of rate trends for the four census regions of the United States.
Data from both surveillance systems showed an approximate doubling of hypospadias rates in the 1970s and 1980s. MACDP data showed that the rate of severe cases increased while the ratio of mild to severe cases decreased. BDMP data showed that hypospadias rates increased markedly in all four regions of the United States.
The observed increases are unlikely to be attributable to increased sensitivity of the surveillance systems or the identification of more mild cases by physicians over time, because either trend would have increased rather than decreased the ratio of mild to severe cases. If real, these trends represent the largest number of cases and the first report of an increase in hypospadias rates outside of Europe. Additional investigation of a possible increase in hypospadias rates is warranted.
A joint international study of the epidemiology of hypospadias.
- Kallen B
- Bertollini R
- Castilla E
Aetiologic factors in hypospadias.
- Kallen B
- Contiero MR
- Roncarati E
Aetiologic factors in hypospadias
- Kallen
Hypospadias trends in two US surveillance systems
- Paulozzi
A joint international study of the epidemiology of hypospadias
- Kallen