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Center for the Study & Treatment of
Hypospadias
Mission Statement
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Clinical excellence in the treatment of hypospadias |
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Research leaders in the study of hypospadias |
The program is composed of an integrated team of pediatric urologists,
endocrinologists, epidemiologists, geneticists, pathologists and
basic scientists.
Clinical Overview
Introduction
Hypospadias is a congenital defect of the penis resulting in
incomplete development of the penile urethra. The abnormal urethral
opening may be any place along the shaft of the penis or may open
onto the scrotum or the perineum. As the position of the urethral
meatus becomes more proximal, ventral shortening and curvature
during penile erection are more likely. In patients with severe
hypospadias, the genitalia may look ambiguous at birth, resulting
in emotional and psychological stress for parents in that the
gender assignment of their baby immediately comes into question.
Left uncorrected, patients with hypospadias may need to sit down
to void and tend to shun intimate relationships because of the
fears related to normal sexuality.
Incidence
Hypospadias is one of the most common congenital anomalies, occurring
in approximately 1 in 250 to 1 in 300 live births. In Europe,
the prevalence of hypospadias in the 1970's and 1980's has been
increasing with no obvious explanation. In the United States,
data from two birth defects surveillance systems has also shown
an unexplained doubling in the incidence of hypospadias. (Paulozzi,
Erickson et al. 1997) The U.S. study from the Centers for Disease
Control is particularly intriguing in that the incidence of severe
hypospadias, not just mild forms, is increasing, implying that
the increase in hypospadias is not due to an increase in surveillance
or reporting.
Treatment
The only treatment for hypospadias is surgical repair of the
anatomical defect. (Baskin, Duckett et al. 1994; Baskin, Duckett
et al. 1996; Duckett and Baskin 1996; Baskin and Duckett 1998)
In experienced hands, the surgery is typically performed as an
outpatient procedure, with 80-90% of children requiring one operation.
Occasionally extensive surgery is necessary, and in some cases
multiple operations leave the unfortunate child with a suboptimal
result, the patient then being classified as a "hypospadias
cripple". (Baskin and Duckett 1995) The health care dollars
spent on hypospadias surgery are certainly significant when you
consider hospital cost, physician fees and time away from work
caring for these young patients. The morbidity of surgery is also
important in that patients with severe hypospadias will require
a urethral stent or catheter in the postoperative period. In 1996,
approximately 2 million males were born in the United States,
which translates to approximately 7000 new cases of hypospadias
based on an incidence of 1 in 300.
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Images of the nerve supply to the normal female,
normal male, and hypospadias. |
Basic and Translational Research Center
Etiology
The cause of hypospadias is still unknown. The goal of the Hypospadias
Research Center is to define the etiology of hypospadias and to
translate basic science findings to possible prevention or new
treatment options. Accomplishing this goal will require the expertise
and collaboration of scientists from multiple disciplines. The
areas presently under consideration are:
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Endocrinology and androgen metabolism |
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Cellular signaling in the urinary tract |
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Animal models |
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Epidemiological Studies |
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Molecular Genetics |
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Endocrine Disrupters |
Clinical References |
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Baskin, L.S.: Hypospadias: a critical analysis of cosmetic
outcomes using photography. British Journal of Urology,
International 2001; 87 534-537. |
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Akman, Y, Liu, W-H, Lee, Y-W and Baskin, LS: Penile anatomy
under the pubic arch: Constructive implications. J Urol.,
166:225-230, 2001. |
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Baskin, LS: Hypospadias Frontiers. Pediatrics
Current Medical Literature. 13:4, 85-88, |
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Baskin, LS, A Erol, YW Li, WH Liu, "Anatomy
of the neurovascular bundle: Is safe mobilization possible?"
J Urology, Pediatric Supplement 164:977-980, 2000. |
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Baskin, LS, "Hypospadias: Anatomy, Embryology,
and Reconstructive Techniques." Brazilian J Urology
26(6):621-9, 2000. |
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Erol, A, LS Baskin, YW Li, WH Liu, "Anatomical
studies of the urethral plate: Why preservation of the urethral
plate is important in hypospadias repair." British
J Urology 85:728-734, 2000. |
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Baskin, LS, "Fetal genital anatomy reconstructive
implications." J Urology 162(2):527-9, 1999. |
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Baskin, LS, A Erol, YW Li, WH Liu, E Kurzrock
and GR Cunha, "Anatomical studies of the human clitoris."
J Urology 162:1015-1020, 1999. |
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Baskin, LS, A Erol, WH Liu, and GR Cunha, "Anatomical
Studies of Hypospadias." J Urology 160:1108-1115, 1998.
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Baskin, LS and J Duckett, "Hypospadias:
Long-Term Outcomes. Pediatric Surgery and Urology: Long-Term
Outcome." M Pierre DE Mouriquand. London, WB Saunders:
559-567, 1998. |
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Baskin, LS and TF Lue, "The correction
of congenital penile curvature in young men." British
J Urology 81(6):895-9, 1998. |
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Zaontz, MR, RE Steckler, LM Shortliffe, BA Kogan,
LS Baskin, and S Tekgul, "Multicenter experience with
the Mitchell technique for epispadias repair." J Urology
160(1):172-6, 1998. |
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Baskin, LS, DA Canning, et al, "Surgical
repair of urethral circumcision injuries." J Urology
158(6): 2269-71, 1997. |
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Baskin, LS, "Controversies in Hypospadias
Surgery: Penile Curvature Part 1." Dialogues in Pediatric
Urology William Miller Publisher 19(7): 1-8, 1996. |
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Baskin, LS, "Controversies in Hypospadias
Surgery: The Urethral Plate Part II." Dialogues in
Pediatric Urology William Miller Publisher 19(8): 1-8, 1996.
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Baskin, LS, J Duckett, and T Lue, "Penile
Curvature." Urology 48(3):347-356, 1996. |
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Baskin, LS, DA Canning, et al, "Treating
complications of circumcision." Pediatric Emergency
Care 12(1): 62-8, 1996. |
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Duckett, J and LS Baskin, "Hypospadias.
Adult and Pediatric Urology." J Gillenwater, J Grayhack,
S Howards and J Duckett. St. Louis, Mosby, 1996. |
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Baskin, LS and JW Duckett, "Buccal mucosa
grafts in hypospadias surgery." British J Urology 76
Suppl 3: 23-30, 1995. |
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Duckett, J, D Coplen, et al, "Buccal Mucosa
in Urethral Reconstruction." J Urology 153: 1660-3,
1995. |
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Baskin, LS and JW Duckett, "Dorsal tunica
albuginea plication for hypospadias curvature." J Urology
151(6): 1668-71, 1994. |
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Baskin, LS, JW Duckett, et al, "Changing
concepts of hypospadias curvature lead to more onlay island
flap procedures." J Urology 151(1): 191-6, 1994. |
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Daskalopoulos, EI, LS Baskin, et al, "Congenital
penile curvature (chordee without hypospadias)." Urology
42(6): 708-12, 1993. |
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Research References |
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Baskin, LS, Erol, A, Jegatheeson, P, Lee, Y-W,
Liu W-H, Cunha, JR: Urethral seam formation in hypospadias.
Cell Tissue and research, 305:379-387, 2001. |
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Baskin, L.S., Himes, K and Colburn, T: Hypospadias
and Endocrine Disruption : Is there a connection? Environmental
Health Perspectives: vol 109 #111:1175-1183, nov 2001. |
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Erol, A., Baskin, L.S., Li, Y. W., Liu, W. H.:
Anatomical studies of the urethral plate: Why preservation
of the urethral plate is important in hypospadias repair.
British Journal of Urology 85, 728-734, 2000. |
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Kurzrock, E., P. Jegathanson, Baskin, LS: "Urethral
Development in the Fetal Rabbit and Induction of HypospadiasJ.
Urol 164:1786-1794, 2000. |
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Kurzrock, EA, P Jegatheesan, GR Cunha and LS
Baskin, "Urethral development in the fetal rabbit and
induction of hypospadias: a model for human development."
J |
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Urology 164:1786-1792, 2000. |
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Baskin, LS, "Hypospadias and urethral development."
J Urology 163(3):951-6, 2000. |
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Baskin, LS, A Erol, YW Li, WH Liu, EA Kurzrock
and GR Cunha, "Anatomical studies of the human clitoris."
J Urology 162:1015-1020, 1999. |
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Kurzrock, EA, LS Baskin, GR Cunha, "Ontogeny
of the Male Urethra: Theory of endodermal differentiation."
Differentation 64: 115-122, 1999. |
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Kurzrock, EA, LS Baskin, et al, "Epithelial-mesenchymal
interactions in development of the mouse fetal genital tubercle."
Acat Anatomica in press, 1999. |
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Baskin, LS, YT Lee, et al, "Neuroanatomical
ontogeny of the human fetal penis." Br J Urol 79(4):
628-40, 1997. |
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Baskin, LS, RS Sutherland, et al, "The effect
of testosterone on androgen receptors and human penile growth."
J Urol 158(3 Pt 2): 1113-8, 1997. |
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Sides, D, RB Goldstein, et al, "Prenatal
diagnosis of hypospadias." J Ultrasound Med 15(11):
741-6, 1996. |
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Sutherland, RS, BA Kogan, et al, "The effect
of prepubertal androgen exposure on adult penile length."
J Urology 156(2 Pt 2): 783-7; discussion 787, 1996. |
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Baskin, LS. Society for fetal urology panel discussion:
prenatal diagnosis and treatment of genital anomalies. |
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Baskin, L and J Duckett (1998). Hypospadias:
Long-Term Outcomes. Pediatric Surgery and Urology: Long-Term
Outcome. M Pierre DE Mouriquand. London, WB Saunders: 559-567. |
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Colburn, T. Our Stolen Future (1997). Penguin
Press |
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Allen, TD and J Griffin (1984). "Endocrine
studies in patients with advanced hypospadias." J Urology
131(2): 310-4. |
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Allera, A, and MA Herbst, et al (1995). "Mutations
of the androgen receptor coding sequence are infrequent
in patients with isolated hypospadias." J Clin Endocrinol
Metab 80(9): 2697-9. |
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Gearhart, JP, and HR Linhard, et al (1988). "Androgen
receptor levels and 5 alpha-reductase activities in preputial
skin and chordee tissue of boys with isolated hypospadias."
J Urology 140: 1243-6. |
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Paulozzi, L, and Erickson, et al (1997). "Hypospadias
Trends in Two US Surveillance Systems." Pediatrics
100(5): 831-834. |
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Semenza, JC, and PE Tolbert, et al (1997). "Reproductive
toxins and alligator abnormalities at Lake Apopka, Florida."
Environ Health Perspect 105(10): 1030-2. |
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Sutherland, RW, and JS Wiener, et al (1996).
"Androgen receptor gene mutations are rarely associated
with isolated penile hypospadias." J Urology 156(2
Pt 2): 828-31. |
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Warner, MR, and RL Warner, et al (1979). "Reproductive
tract calculi, their induction, age incidence, composition
and biological effects in Balb/c crgl mice injected as newborns
with estradiol-17b." Biol Reprod 20: 310-322. |
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Faculty
Laurence Baskin,
MD
Michael DiSandro,
MD
Appointments & Location
UCSF
Medical Center, Parnassus Campus
400 Parnassus Avenue, Suite A-610
San Francisco, CA 94143-0330
Contact Number
Clinical Program
Crede Ambulatory Care Center
400 Parnassus Avenue, Suite A-610
For appointments, please telephone 415/353-2200
Research Program
Health Sciences West, 1434
Patient Handouts
Visit our Patient
Guides to Urological Treatments section to download Patient
Handouts.
Laboratory
Baskin Lab
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