ESPU Meeting on Wednesday 17, June 2026, 16:00 - 16:50
16:00 - 16:03
S03-1 (CP)
Nicol BUSH 1, Hazem MOSA 1, Caitlin CHAPMAN 2 and Warren SNODGRASS 1
1) Hypospadias Speciality Center, Dallas, USA - 2) Texas Tech University Health Science Center, Lubbock, USA
PURPOSE
Many families are told their son with proximal hypospadias has micropenis and a small glans. We assessed stretched penile length(SPL) and glans width(GW) in boys with hypospadias to determine the prevalence of micropenis and microglans using age-matched normative data.
MATERIAL AND METHODS
Prospective data was collected in consecutive prepubertal boys(Tanner 1) aged 0-10 years undergoing primary or reoperative hypospadias repair from 2019-24, including those with known underlying genetic conditions. Patients aged ≥11years &/or Tanner 2-5 were excluded. SPL was measured under general anesthesia using a standardized technique. GW was measured with calipers at the onset of the case. Normative reference data were used, comparing SPL and GW at each year of age (Schonfeld and Beebe. JUrol1942;48:759-77). Micropenis and microglans were defined as values< −2.5 standard deviations (SD) for age. We did not prescribe androgen(testosterone or dihydrotestosterone), but subgroup analysis was performed for the minority who received it elsewhere.
RESULTS
A total of 631 patients (median age 13.5 months, 64% proximal) demonstrated average SPL and GW of 5.8cm and 14.7mm, respectively (Table). No patient met micropenis criteria, and only 24/631(3.8%) had microglans. 21 patients had known genetic conditions, of whom 7(33.3%) had microglans and the remainder had normal SPL and GW. Diagnoses included 5ARD(3), MGD(1), PAIS(1), NR5A1/SF-1(1) and 17β-HSD3 deficiency(1).7.9% previously received androgen therapy. No significant difference in age-adjusted median SPL or GW was found between treated and untreated patients.
|
Age in years |
No. of patients(n=631) |
Mean SPL in cm(range) |
Micropenis threshold*(cm) |
#(%)with micropenis(≤2.5SD) |
Mean glans width in mm(range) |
Microglans threshold*(mm) |
#(%)with microglans(≤2.5SD) |
|
<1y |
237 |
4.8(2.8-7.1) |
2.3 |
0 |
14.3(7-21) |
7.6 |
2(0.8%) |
|
1 |
165 |
5.4(3.2-8) |
2.6 |
0 |
14.4(7-19) |
9.2 |
2(1.2%) |
|
2 |
68 |
5.8(4.2-7.9) |
2.9 |
0 |
14.8(11-23) |
10.5 |
0(0%) |
|
3 |
55 |
6.2(4.1-9.2) |
3.3 |
0 |
14.6(9-18) |
11.8 |
4(7%) |
|
4 |
28 |
6.2(3.9-9.2) |
3.5 |
0 |
14.8(11-18) |
12.4 |
4(14%) |
|
5 |
24 |
6.4(4.7-9.1) |
3.8 |
0 |
15.8(11-20) |
13.1 |
3(12.5%) |
|
6 |
15 |
5.9(4-8.2) |
3.9 |
0 |
15.4(9-20) |
13.4 |
2(13%) |
|
7 |
12 |
6.9(5.2-8.3) |
3.7 |
0 |
15.9(11-19) |
14 |
2(16.6%) |
|
8 |
11 |
6.9(5.5-8.5) |
3.8 |
0 |
17.4(15-21) |
14.3 |
0(0%) |
|
9 |
11 |
6.7(5.7-7.9) |
3.8 |
0 |
17.4 (14-23) |
15 |
3(27.2%) |
|
10 |
5 |
6.3(4.7-8.3) |
3.7 |
0 |
15(10-17) |
15.3 |
2(40%) |
Table: Age-stratified summary of SPL and glans width (means/ranges) in 631 consecutive boys with hypospadias.
CONCLUSIONS
In the largest study of SPL in prepubertal boys with hypospadias to date, objective measurements in 631 patients demonstrate none had micropenis, including those with scrotal and perineal hypospadias. 96.2% have normal GW. In the 3.8% with microglans, genetic testing should be considered. Routine labelling of boys with hypospadias as having micropenis not indicated, and need for Testosterone to enlarge a ”small glans” should be quite rare.
16:03 - 16:06
S03-2 (CP)
Dilnur SEVINC 1, Erdem ÇELİK 2 and Sibel TIRYAKI 3
1) Izmir State Hospital, Pediatric Surgery, Izmir, TÜRKIYE - 2) Middle East Technical University, Civil Engineering, Ankara, TÜRKIYE - 3) Ege University Department of Pediatric Surgery, Division of Pediatric Urology, Izmir, TÜRKIYE
PURPOSE
Genetic, epigenetic and environmental risk factors are involved in the etiopathogenesis of hypospadias. This cross-sectional study aimed to evaluate the impact of environmental pollutants on the development of hypospadias.
MATERIAL AND METHODS
Male newborns underwent genital examination by a pediatric surgeon and/or pediatric urologist, and their mothers completed a structured questionnaire. Maternal residential address during the first trimester was recorded to evaluate environmental exposures. Patients’ address data were geocoded via Google Maps to obtain latitude–longitude coordinates; air pollution indicators (PM10, PM2.5, NO2, NOX, SO2, CO, O3) were retrieved from national air quality monitoring stations and interpolated using Kriging method to generate Raster maps. Maternal residential altitude during the first trimester was obtained from Copernicus GLO-DEM-30. Occupational exposure to endocrine-disrupting chemicals was assessed using a job exposure matrix. Environmental pollutant measures, together with currently accused risk factors, were compared between newborns with and without hypospadias. The power analysis indicated that, for α = 0.05 and β = 0.20, a minimum sample size of 1,283 participants was required.
RESULTS
The study included 1400 infants, of whom 90 had hypospadias. In univariate analysis, maternal occupational exposure (p=0.047), predominant use of plastic-bottled drinking water (p=0.033), lower altitude (p=0.015), lower O₃ levels (p=0.028), as well as family history of hypospadias (p<0.001), higher maternal education (p=0.002), higher paternal education (p=0.012), first pregnancy (p=0.024), maternal insulin use (p=0.022), maternal vitamin use (p=0.035), maternal progesterone use (p=0.031), pregnancy during oral contraceptive use (p=0.002), being born SGA (p=0.002), antenatal abnormality diagnosis (p=0.003) and oligohydramnios (p=0.029) were associated with increased rates of hypospadias. No significant association was found between any other air pollution metrics and hypospadias.
In multivariate analysis, only family history (p<0.001, Exp(B)=4.87, 95%CI=2.990-7.938), maternal insulin use (p=0.031, Exp(B)=2.435, 95%CI=1.087–5.455), pregnancy during oral contraceptive use (p=0.015, Exp(B)=12.402, 95% CI=1.617-95.115), antenatal abnormality diagnosis (p=0.036, Exp(B)=1.947, 95%CI=1.044-3.631) and being born SGA (p=0.021, Exp(B)=1.997, 95%CI=1.111-3.589) remained independent risk factors.
CONCLUSIONS
Several environmental and perinatal factors were associated with hypospadias in univariate analysis; however, after adjustment, familial predisposition and markers of impaired fetal growth emerged as independent predictors. These findings support a multifactorial etiology in which genetic susceptibility and adverse intrauterine conditions appear to play a predominant role. The contribution of environmental pollutants requires further investigation.
16:06 - 16:09
S03-3 (CP)
Madhyra Tri INDRASWARI, Putu Angga Risky RAHARJA, Gerhard Reinaldi SITUMORANG, Arry RODJANI and Irfan WAHYUDI
Faculty of Medicine, Universitas Indonesia, Urology, Jakarta, INDONESIA
PURPOSE
Preoperative hormonal stimulation (PHS) in hypospadias aims to increase penile/glans size and improve tissue vascularity, potentially facilitating surgical repair. However, data on effects specifically on dartos tissue morphology are limited. This study aimed to evaluate the effect of PHS on dartos tissue in hypospadias patients undergoing repair.
MATERIAL AND METHODS
In this prospective case-control study, 100 dartos tissue samples were collected from hypospadias patients undergoing repair surgery: 42 patients received PHS and 58 did not. Histochemical staining was used to assess collagen density, smooth muscle density, vessel density, and tissue thickness. Statistical comparisons between groups were performed.
RESULTS
Compared with non-PHS controls, the PHS group demonstrated significantly higher smooth muscle density (23.0% vs 20.0%, p < 0.001) and vessel density (8.5% vs 8.0%, p < 0.001), and a modest but statistically significant decrease in collagen density (42.5% vs 43.0%, p = 0.001). There was no significant difference in dartos thickness or in the smooth-muscle architectural configuration between groups. Moreover, penile morphometry revealed a longer external meatus-to-tip length in the PHS group (24 mm vs 21 mm, p < 0.001).
CONCLUSIONS
PHS in hypospadias patients is associated with increased smooth muscle and vessel density and reduced collagen density in dartos tissue, without altering tissue thickness. The observed modifications, potentially enhancing tissue vascularity and pliability, may provide more favorable conditions for hypospadias repair. These findings support the use of PHS to optimize surgical tissue quality, although further studies are needed to define optimal dosing, long-term histologic effects, and correlation with postoperative outcomes.
16:09 - 16:12
S03-4 (CP)
Khalid ALALAWI 1, Tudor ENACHE 1, Julie CARION 2, Céline GROSOS 1, Patricia BRETONES 2, Ingrid PLOTTON 3, Delphine DEMEDE 1 and Valeska BIDAULT JOURDAINNE 4
1) Hospices Civils de Lyon, Pediatric urovisceral, thoracic and transplantation surgery, Bron, FRANCE - 2) Hospices Civils de Lyon, Pediatric endocrinology, Bron, FRANCE - 3) Hospices Civils de Lyon, Laboratoire de Biochimie et Biologie Moléculaire multi-sites, Bron, FRANCE - 4) Hospices Civils de Lyon, Pediatric surgery, Bron, FRANCE
PURPOSE
Anti-Müllerian hormone (AMH) is a Sertoli cell hallmark that participates in the regression of Müllerian ducts during male fetal development, and is commonly used in assessment of atypical genital development in boys. However, AMH level capacity to predict the presence of an enlarged prostatic utricle or Müllerian remnants remains uncertain. This study aims to establish the relation between neonatal AMH level and the presence of Müllerian-derived structures in boys with Disorders of Sexual Development (DSD) or proximal hypospadias.
MATERIAL AND METHODS
Retrospective monocentric cohort study including all male DSDs and proximal hypospadias treated between 2006 and 2024. Patients with distal hypospadias were excluded. External Masculinisation Score (EMS), meatal position, penile curvature, karyotype, neonatal and mini-puberty hormonal values and imaging modalities to detect prostatic utricle or Müllerian remnants were collected. Comparative analyses used non-parametric tests, chi-square, and Spearman correlation.
RESULTS
Among 252 boys presented with penoscrotal or perineal hypospadias or male DSD, 223 (88,5%) had penoscrotal or perineal hypospadias, and the remaining proximal forms were investigated for suspected 46,XY DSD. Significant ventral curvature (>30°) was present in 63% of cases. Most patients had a 46,XY karyotype (209 patients, 93,7%), 6 (2,7%) had mixed gonadal dysgenesis (45,X0/46,XY), and 4 (1,8%) had Klinefelter syndrome (47,XXY). Pathogenic or likely pathogenic variants on targeted genetic panels were rare (27 mutations identified, 12,1%), involving defects of androgen synthesis or action. Neonatal AMH was available in 89 infants, with a median value of 325 pmol/L (IQR 224–535). Pelvic imaging (ultrasound or MRI) or cystoscopy was performed in 85 boys, identifying six Müllerian-derived structures or enlarged utricles. Median AMH did not differ between boys with and without Müllerian remnants (258 vs 251 pmol/L; p=0.89). AMH values were also comparable between severe and non-severe phenotypes (320.5 vs 421 pmol/L; p=0.74) and showed no correlation with EMS (r=0.13; p=0.25).
CONCLUSIONS
These findings demonstrate that neonatal AMH is not a reliable predictor of either hypospadias severity or the presence of Müllerian remnants, supporting the need for multimodal evaluation through combined endocrine, clinical, and anatomical assessment.
16:27 - 16:31
S03-5 (BSP)
Ayşe KARAGÖZ HAKALMAZ 1, Hakan ŞAHİN 2, Merjem PURELKU 3, Ni̇l ÇOMUNOĞLU 4, Gamze TANRIVERDİ 2, Meral KOYUTÜRK 2 and Haluk EMİR 5
1) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pediatric Surgery, İstanbul, TÜRKIYE - 2) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Histology and Embryology, İstanbul, TÜRKIYE - 3) Bahçeşehir University, Faculty of Medicine, Department of Histology and Embryology, İstanbul, TÜRKIYE - 4) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pathology, İstanbul, TÜRKIYE - 5) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pediatric Surgery, Division of Pediatric Urology, Istanbul, TÜRKIYE
PURPOSE
Penile tourniquet (PT) is commonly used to achieve hemostasis in penile surgery. Although the ultrastructure of the corpus cavernosum (CC) has been described previously, detailed investigations of PT-induced changes remain limited. Our previous study demonstrated that continuous artificial erection (CAE) does not increase the tissue damage caused by PT, but rather shows potential to reduce it. This study aims to characterize the ultrastructure of the rat CC and investigate the PT-induced alterations in the presence or absence of CAE.
MATERIAL AND METHODS
Thirty-five Sprague-Dawley rats were randomized into five groups (one control and four experimental groups). Experimental groups received either 20 or 40 minutes of isolated PT (20T and 40T), or PT combined with CAE (20T&E and 40T&E). CAE was achieved by continuous intracavernosal saline infusion. Penectomy was performed three weeks after the procedures, and control animals were sampled at the same time. CC samples were examined using transmission electron microscopy (TEM) for descriptive ultrastructural analysis and assessment of endothelial integrity.
RESULTS
Control tissues exhibited wide irregular vascular spaces lined by intact endothelial cells and a thin smooth muscle layer occasionally forming subendothelial cushions. Notably, telocytes were identified throughout the stroma as interstitial cells characterized by long cytoplasmic extensions (telopods) containing mitochondria, rough endoplasmic reticulum and variably sized vesicles. Telocytes appeared interconnected through telopods and showed close associations with smooth muscle cells, endothelial cells, and nerve endings. PT and PT+CAE groups demonstrated time-dependent ultrastructural alterations in endothelial integrity and activity, including changes in vesicle number and distribution, and modifications in subendothelial structures as the basal lamina and extracellular matrix. These changes were most pronounced in 40T and 40T&E. Additionally, we demonstrated distinct telopod localization and activity patterns, documented for the first time in this context.
CONCLUSIONS
This study reveals previously unreported ultrastructural characteristics of the CC, including the first evidence of telocytes in this tissue. PT and CAE were shown to induce time-dependent ultrastructural alterations, and telopod differences suggest a potential telocyte-mediated role in penile tissue response to injury, that merits further investigation.
16:31 - 16:34
S03-6 (CP)
Gunay EKBERLI 1, Suleyman TAGCI 2, Bilge KARABULUT 2 and Huseyın Tugrul TIRYAKI 2
1) ANKARA BILKENT CITY HOSPITAL, DEPARTMENT OF PEDIATRIC UROLOGY, Ankara, TÜRKIYE - 2) ANKARA BILKENT CITY HOSPITAL, PEDIATRIC UROLOGY, Ankara, TÜRKIYE
PURPOSE
Penile ischemia in children is a rare but potentially devastating condition that may arise after surgical procedures or traumatic events, risking tissue loss and long-term functional impairment. Hyperbaric oxygen therapy (HBOT) has been increasingly utilized as an adjunct to enhance oxygen delivery, stimulate neovascularization, and support tissue viability. This study evaluates the clinical outcomes of HBOT in pediatric penile ischemia of varying etiologies.
MATERIAL AND METHODS
A retrospective review was conducted of 12 pediatric patients who received HBOT for penile ischemia between January 2020 and January 2025. Patients with chronic wounds or hemorrhagic cystitis were excluded. Etiology, timing of HBOT initiation, clinical course, treatment response, and the need for additional surgical intervention were recorded and analyzed.
RESULTS
The patients ranged from 6 months to 17 years (mean 5.3 ± 4.4 years). HBOT was administered following penile surgery in 10 cases (83%) and for non-surgical causes in 2 cases (17%). None of the patients received HBOT within the first 24 hours. Complete recovery occurred in six patients (50%), all of whom had superficial ischemia. Five patients achieved partial recovery, while one patient with total necrosis required forearm flap reconstruction. Delayed HBOT initiation and systemic comorbidities were associated with poorer outcomes.
CONCLUSIONS
HBOT appears to be a safe and valuable adjunct in the management of pediatric penile ischemia. Even when initiated beyond 24 hours, HBOT may facilitate tissue salvage and optimize conditions for secondary reconstruction. Early recognition and prompt referral to hyperbaric units remain essential. Prospective studies are needed to establish standardized treatment protocols and assess long-term outcomes.
16:34 - 16:37
S03-7 (CP)
Niklas PAKKASJÄRVI 1, Annaleena ANTTILA 2 and Seppo TASKINEN 3
1) New Children's Hospital, Helsinki University Hospital, Dept of Paediatric Surgery, Section of Urology, Helsinki, FINLAND - 2) Helsinki University Hospital, Dept of Paediatric Surgery, Section of Urology, Helsinki, FINLAND - 3) Helsinki University Hospital, Department of Paediatric Surgery, Section of Urology, Helsinki, FINLAND
PURPOSE
Decisional regret from a patient perspective in adolescence after early childhood hypospadias repair is poorly reported. To fill that gap, we assess adolescent satisfaction with outcomes and evaluate decisional regret and examine whether this is associated with anatomical severity, postoperative complications, and the need for reoperations.
MATERIAL AND METHODS
Adolescents who had undergone primary hypospadias repair in early childhood were asked to complete a pre-mailed questionnaire prior to their final paediatric follow-up visit. The survey included the validated Penile Perception Score (PPS), addressing satisfaction with meatal position, glans configuration, penile skin, and overall appearance. Additional items explored satisfaction with penile length and straightness, perceived appropriateness of operative timing, and decisional regret. Previously published normative data from age-matched healthy controls served as reference.
RESULTS
176 patients responded, including 101 distal, 20 midshaft, and 55 proximal hypospadias. Median age at primary repair and at assessment was 1.4 years (IQR 1.1-1.8) and 16.3 years (IQR 16.0-16.8), respectively. 51% had undergone at least one unplanned reoperation. Satisfaction with meatal location, glans appearance, penile skin, and straightness did not differ significantly from controls. Dissatisfaction with penile length (18.6% vs 0%; p < 0.01) and overall appearance (11.8% vs 1.6%; p = 0.03) was more frequent among patients. PPS scores were generally more favourable after distal compared with proximal repairs, particularly for glans appearance, penile length, and straightness. Dissatisfaction with penile length was more common in adolescents who had curvature necessitating correction after degloving (Nesbit procedure: 26% vs 12%; p = 0.03). Most respondents (89.8%) considered the timing of primary surgery appropriate; decisional regret was reported by 2.9% and was not associated with age at primary repair.
CONCLUSIONS
Adolescents expressed high overall satisfaction with early hypospadias repair. Dissatisfaction was mainly related to penile length and was more pronounced in proximal cases. Decisional regret was rare, supporting early repair when combined with structured counselling and long-term follow-up.