Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo 060-0824, Japan.
J Urol. 2010 Oct;184(4 Suppl):1610-4. doi: 10.1016/j.juro.2010.04.022. Epub 2010 Aug 21.
Reports of pubertal hormonal and gonadal status in patients with hypospadias are scarce. We evaluated the pituitary-gonadal axis and gonadal growth in patients with hypospadias at puberty.
We retrospectively reviewed serum luteinizing hormone, follicle-stimulating hormone, testosterone and testicular volume at puberty (age 15 years or greater) in the medical charts of patients with hypospadias treated since 1986 and followed at our institution.
Enrolled in this study were 43 patients with a mean age at evaluation of 17.6 years (range 15.1 to 22.8). Of these patients 14 and 29 were treated for mild and severe hypospadias, respectively. Six patients with severe hypospadias underwent bilateral orchiopexy for bilateral undescended testes. All patients were Tanner stage 4 to 5 at evaluation. Of 14 mild hypospadias cases we noted hypergonadotropic hypogonadism, hypogonadotropic hypogonadism, decreased luteinizing hormone and decreased testosterone in 1 each (7% each). Of 23 severe hypospadias cases without bilateral undescended testes we noted hypergonadotropic hypogonadism, partial androgen insensitivity syndrome and decreased testosterone in 2 (9%), 1 (4%) and 1 (4%), respectively. Of 6 patients with severe hypospadias and bilateral undescended testes we noted hypergonadotropic hypogonadism in 1 (17%) and increased luteinizing hormone with normal testosterone in 2 (33%). Testicular volume less than 10 ml with increased follicle-stimulating hormone was identified in 7 of 43 patients, including 1 of 14 (7%) with mild hypospadias, 3 of 23 (13%) with severe hypospadias without bilateral undescended testes and 3 of 6 (50%) with severe hypospadias and bilateral undescended testes.
Our study revealed endocrine dysfunction in patients with mild and severe hypospadias at puberty even without an undescended testis. Of these patients those with severe hypospadias and an undescended testis may be at higher risk for impaired spermatogenesis.
有关尿道下裂患者青春期性腺激素和性腺状态的报道很少。我们评估了青春期尿道下裂患者的垂体-性腺轴和性腺发育情况。
我们回顾性分析了自 1986 年以来在我们机构接受治疗并随诊的尿道下裂患者的血清促黄体生成素、卵泡刺激素、睾酮和睾丸体积，这些患者在青春期（15 岁或以上）时接受了评估。
本研究共纳入 43 例患者，平均评估年龄为 17.6 岁（范围 15.1 至 22.8 岁）。其中 14 例和 29 例患者分别接受了轻度和重度尿道下裂治疗。6 例重度尿道下裂患者因双侧隐睾而行双侧睾丸固定术。所有患者评估时均处于 Tanner 分期 4 至 5 期。14 例轻度尿道下裂患者中，我们发现 1 例（7%）存在促性腺激素性性腺功能减退症，1 例（7%）存在促性腺激素低能性性腺功能减退症，1 例（7%）存在黄体生成素减少，1 例（7%）存在睾酮减少。23 例无双侧隐睾的重度尿道下裂患者中，我们发现 2 例（9%）存在促性腺激素性性腺功能减退症，1 例（4%）存在部分雄激素不敏感综合征，1 例（4%）存在睾酮减少。6 例双侧隐睾的重度尿道下裂患者中，我们发现 1 例（17%）存在促性腺激素性性腺功能减退症，2 例（33%）存在黄体生成素增加和正常睾酮。43 例患者中有 7 例（17%）睾丸体积小于 10ml 且卵泡刺激素增加，其中 1 例（7%）为轻度尿道下裂，3 例（13%）为无双侧隐睾的重度尿道下裂，3 例（50%）为双侧隐睾的重度尿道下裂。
即使没有隐睾，我们的研究也揭示了轻度和重度尿道下裂患者在青春期存在内分泌功能障碍。其中，重度尿道下裂伴隐睾的患者可能更有可能出现精子生成受损。
