Upper urinary tract anomalies associated with congenital hypospadias: is screening necessary?

Conflicting reports in regard to the incidence of upper urinary tract abnormalities associated with hypospadias have appeared in the urological literature during the last 25 years. We reviewed the charts of 301 patients with hypospadias, 233 of whom had either an excretory urogram or renal ultrasound as routine screening examinations. An abnormality of the upper urinary tract was detected in 4, 2 of whom had an indication for upper tract evaluation owing to additional congenital abnormalities. Only 1 of the remaining 2 patients required intervention for the discovered abnormality, making clinical screening useful in only 0.4 per cent of the group. Severity of hypospadias was unrelated to the incidence of upper urinary tract abnormality. We conclude that routine imaging of the upper urinary tract in patients with hypospadias is of minimal clinical use.