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Pathogenesis of Hypospadias: The Disorganization Hypothesis

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Hypospadias Surgery

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Abstract

The pathogenesis of hypospadias remains a matter of speculation. Most studies suggest that it is due to failure of fusion of the urethral folds. The associated anomalies such as the variable pattern and depth of the urethral plate, different glans configuration, torsion and raphe anomalies, as well as chordee are not explained by the failure of fusion of urethral folds.

Clinical and operative findings of more than 1000 patients with hypospadias are correlated with histological studies on the development of the urethra.

Histological sections of fetuses with hypospadias have shown disorganized arrangement of corpus spongiosum and ventral penile fascia. Normal differential migration and proliferation of the dorsal mesenchyme causes transient chordee. Inadequate distal migration and disorganized growth of the ventral penile mesenchyme causes persistent chordee. Disorganized growth and inadequate degeneration of the caudal cells of the urethral plate may explain the variable width and depth of the urethral plate. Disorganized degeneration of the solid epithelial plate in the glans region explains the variable degree of glans clefting. Asymmetrical disorganized distal migration mesenchyme to develop the corpus spongiosum and ventral fascia on either side of the midline explains torsion and rotation of the penis. The “disorganization hypothesis” postulates that hypospadias and related anomalies are probably due to disorganized growth and migration of the ventral penile mesenchyme. This results in disorganized growth of the urethra, corpus spongiosum, and fascial structures on the ventral aspect of the penis.

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Abbreviations

ASD:

Anoscrotal distance

MIP:

Megameatus intact prepuce

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Authors and Affiliations

  1. Hypospadias Center and Pediatric Surgery Department, Sana Klinikum Offenbach, Academic Teaching Hospital of the Johann Wolfgang Goethe University, Offenbach, Frankfurt, Germany

    Ahmed T. Hadidi

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  1. Hypospadias Center and Pediatric Surgery Department, Sana Klinikum Offenbach, Academic Teaching Hospital of the Johann Wolfgang Goethe University, Offenbach, Frankfurt, Germany

    Ahmed T. Hadidi

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Hadidi, A.T. (2022). Pathogenesis of Hypospadias: The Disorganization Hypothesis. In: Hadidi, A.T. (eds) Hypospadias Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-94248-9_7

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  • DOI: https://doi.org/10.1007/978-3-030-94248-9_7

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